Mathematica, a Centers for Medicare and Medicaid Services contractor, held its annual child and adult core set stakeholder workgroup meeting May 4–6, to vote on changes to the Medicaid core sets of quality measures. The workgroup is made up of federal agency liaisons, Medicaid and Children’s Health Insurance Program (CHIP) stakeholders, and measurement experts that develop recommendations for changes.
The workgroup discussed measure gaps and areas for future measure development, and provided an opportunity for public comment. The workgroup voted on 22 measures for the 2022 Medicaid core sets; 14 measures were added and seven were suggested for removal.
To support primary care access and preventive care, the workgroup proposes inclusion of a colorectal cancer screening measure. The new measure focuses on the percentage of patients 50 to 75 years of age who had appropriate screening for colorectal cancer. The American College of Radiology® (ACR®) supports inclusion of this measure in the core set as it is an important policy consideration to address gaps in care for minority populations and improve cancer mortality rates.
Courtney Moreno, MD, a member of the ACR Colon Cancer Committee, provided verbal comments in support of inclusion of the measure. There also was overwhelming stakeholder support from the colon cancer community. The workgroup voted unanimously to recommend adding colorectal cancer screening as a quality measure to the 2022 core set.
The workgroup also discussed the need to include preventive screening measures that address men’s health (e.g., prostate cancer), data collection methods and stratification of measures to support equitable access to care.
Upcoming Review Activities and Selection Process
The workgroup is expected to release a draft report of its recommendations in July for public comment, and the final report in August. Between September and December, the Center for Medicaid and CHIP Services (CMCS) will review the final report and seek additional stakeholder input. By December 31, the 2022 Medicaid Core Set measures will be released to the public via a CMCS Informational Bulletin.
Core Sets Purpose
The Medicaid and CHIP child core set and adult core set contain measures that can be used to estimate the overall national quality of healthcare for Medicaid and CHIP beneficiaries. The core sets are comprised of quality measures collected at the state level. By statute, state reporting is voluntary but will become mandatory in 2024. CMS has developed a document with more information about core sets and annual review.
Information about workgroup meetings, resources and reports is available on the Mathematica website.