Consumer-Oriented Quality Measures

These measurements are important to ensure that ACOs are delivering quality care to consumers. States should require ACOs to report or achieve outcomes on quality measures to continue receiving funding or incentive payments. By tying together quality measurement and funding, ACOs are incentivized to provide quality, coordinated care that improves consumer outcomes. 

Does your state Medicaid ACO program do the following?

  • Solicit the feedback of consumers, consumer advocates and other community stakeholders when quality measures are developed and chosen to ensure that community priorities are reflected in the ACO’s performance evaluation. Communities can provide input through public forums, advisory groups and/or surveys.

  • Focus on outcome measures, particularly patient-reported outcomes, which provide information on consumers’ health and functioning. Measures should include patient experience measures,patient-reported outcome measures and patient goals-directed measures.

  • Quality measurement should include information on health disparities. Data should be disaggregated and stratified by race, ethnicity, primary language, gender identity, sexual orientation, and disability status to measure progress on reducing disparities.

  • Quality metrics should not solely focus on measuring reductions in the use of health care services or spending. An overemphasis on reducing spending or service utilization can encourage ACOs to deny treatment to consumers based on a desire to reduce costs. 

  • Measures should be customized for the targeted populations. If the ACO serves a population with high substance use disorders and mental health needs, the measures should reflect those needs. Similarly, if long-term services and supports (LTSS) are included, then LTSS measures should be incorporated. If children are part of the ACO, consider the use of a separate measure set for children that draws on the CHIP Core Set.

  • Include measures that assess problems consumers have with their care, such as patterns in consumer appeals and grievances and disenrollment from the program. See the Ombudsman section for more information.

  • Present quality measures data publicly in an easily accessible and intelligible way on at least an annual basis.

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