Development of Care Coordination Measures for Medicare Advantage Plans

Official Title
Medicare Advantage Care Coordination Measure Development
United States
9/2015 – 9/2017
IMPAQ Health Practice Areas
Practice Areas
Administrative Health Data
Health Care Performance Measures
Patient Safety and Quality
Quality Measurement and Reporting
Quality of Care
Performance Measurement & Quality Improvement
Centers for Medicare & Medicaid Services
Data Analytics
Performance Metrics Development

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). Currently, CMS relies on patient-reported data to assess these efforts.

IMPAQ is developing quantifiable measures to measure and compare the extent and quality of care coordination services provided to beneficiaries enrolled in MA plans. We are also providing 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 are using 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 consists of two simultaneous efforts: examining key MA encounter data elements for feasibility and identifying and developing care coordination measure concepts. We will develop, test, and validate 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 includes senior researchers, analysts, and measure developers with decades of experience in quality improvement, measure development, data analytics, survey design, and sampling.