Effective care coordination, a key component of the Centers for Medicare & Medicaid Services’ (CMS) Quality Strategy goals, contributes to better health and smarter spending for Medicare beneficiaries enrolled in Medicare Advantage (MA). CMS previously relied on patient-reported data to assess these efforts.
IMPAQ developed quantifiable measures to measure and compare the extent and quality of care coordination services provided to beneficiaries enrolled in MA plans. We also provided suggestions for incorporating these measures into existing MA quality measurement programs, including the Part C Star Ratings system.
To develop the care coordination measures, we used MA encounter data, which contain diagnosis and treatment information for all services and items (such as encounters) provided to enrollees in managed care plans. Our work consisted of two simultaneous efforts: examining key MA encounter data elements for feasibility and identifying and developing care coordination measure concepts. We developed, tested, and validated a number of care coordination measures and convene a panel of subject matter experts to review our work prior to making our recommendations.
We have worked extensively in this area, including with CMS to develop and implement quality rating system measures for qualified health plans and to evaluate the performance of Medicare Part D organizations. Our team included senior researchers, analysts, and measure developers with decades of experience in quality improvement, measure development, data analytics, survey design, and sampling.