Journal Issue: Health Insurance for Children Volume 13 Number 1 Spring 2003
Quality and Performance Measurement
Policymakers, purchasers, researchers, health care providers, and consumers have become increasingly concerned about the quality of health care provided through both commercial and publicly funded insurance programs.109 Considerable progress has been made in recent years toward developing and testing quality-measurement strategies and tools related to the care received by children and adolescents. For example, some quality-measurement tools include items of particular importance to adolescents, such as adolescent well-care visits; screening for chlamydia; utilization of mental health services; screening, counseling, and treatment for substance abuse and chemical dependency; immunization status; and counseling for risk behaviors and other issues such as diet, exercise, and emotional health.110
Nevertheless, only a small number of states have adopted these measures or items for their Medicaid and SCHIP programs, and little is currently known about how adolescents use services in Medicaid and SCHIP or the quality of services that these programs provide.111 For example, while every state is collecting quality or performance data related to SCHIP enrollees' use of health care services, few states have established performance goals or strategic objectives for SCHIP that address issues of particular importance to adolescents. Of the 33 states that included performance measures related to immunization status in their Fiscal Year 2001 annual reports for SCHIP, only 10 reported measuring the immunization status of adolescents.112 Similarly, while 32 states are collecting data related to annual well-child visits, only 14 states specifically report collecting data related to annual well-adolescent visits. Even for measures that are relevant for all enrollees regardless of age, such as access to a usual source of care, improving EPSDT screening rates, or increasing Medicaid and SCHIP enrollment, only a small number of states are collecting or reporting these findings by age group, making it impossible to determine if the programs are serving children and adolescents equally well or poorly.
To promote a better understanding of how adolescents use services in Medicaid and SCHIP, and the quality of services that these programs provide:
- The federal government and states should collect, analyze, and report quality and performance data in a consistent and uniform way, by appropriate categories including age group, gender, race, ethnicity, and primary language.
- States working with consumers (including adolescents), purchasers, health plans, and health care professionals with expertise in caring for adolescents should adopt adolescent-specific performance measures designed to monitor clinical effectiveness, use of services, access, and satisfaction with care.
- Quality assurance and performance assessment should include measures that focus on health promotion and prevention, including counseling and screening related to health-compromising behaviors, unwanted pregnancy and sexually transmitted infections, diet, weight, asthma, exercise, depression, and mental health.
- States should require that all purchasers, including Medicaid and SCHIP plans, adhere to the HEDIS guidelines that are specific to or relevant to the care of adolescents.