News & Events > United Hospital Fund Report Assesses the Measurement of Quality of Care for Medicaid Beneficiaries with Complex Needs

A new report from the Medicaid Institute at United Hospital Fund focuses on measuring quality of care for Medicaid beneficiaries with complex needs, including those with multiple chronic conditions, behavioral health conditions, and long-term care needs. The report examines the use of quality measurement as a tool to advance the state’s goals of reimbursement reform and service delivery redesign, which includes moving patients with complex needs from fragmented fee-for-service care to managed care and other care management models.

While measuring quality of care for all beneficiaries is important, patients with complex needs present special measurement challenges. Existing measures are too broad and inadequate for monitoring these populations, notes the report, Measuring Quality for Complex Medicaid Beneficiaries in New York. A piecemeal approach that blends measurement tools does not meet the need for coordination and targeted measurement strategies. Challenges include assessing the effectiveness of transitions across health care settings and the coordination of care among primary care, acute care, and social services. In addition, many patients with complex health issues are at greater risk for adverse medication interactions, since many of them are prescribed multiple medications.

The report also underscores the importance of taking the time to clarify the goal of measurement, whether it will be used for quality improvement, accountability, and evaluation; for stratifying the population to identify those at risk; or, especially relevant to New York, for demonstrating the effectiveness of the health home model to the Centers for Medicare and Medicaid Services.

“Getting the measurement strategy right is critical,” said Michael Birnbaum, vice president and director of the Fund’s Medicaid Institute. “When the state’s purchasing decisions are informed by sound quality measurement data, health care delivery will change to prioritize what is being measured. For patients with complex needs—some of the most vulnerable Medicaid beneficiaries—the difference that can make is significant.”

“This report demonstrates the complexity of the state’s measurement challenge for patients with complex needs,” said Jim Tallon, president of the United Hospital Fund. “New York is better positioned than other states, though, because of the tools that are already in place and because of the state’s leadership in and vision for quality measurement. This report does not aim to provide all the answers; rather, it helps raise the key questions needed to get to where we want to be.”

Measuring Quality for Complex Medicaid Beneficiaries in New York was prepared for the Fund’s Medicaid Institute by Alice Lind, RN, MPH, of the Center for Health Care Strategies.

About the United Hospital Fund: The United Hospital Fund is a health services research and philanthropic organization whose primary mission is to shape positive change in health care for the people of New York.

About the Medicaid Institute: The Medicaid Institute at United Hospital Fund provides information and analysis explaining New York’s Medicaid program, with the goal of helping all stakeholders redesign, restructure, and rebuild the program.

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