Recommendations Made by the National Quality Forum on Medicaid Measures
The National Quality Forum (NQF) is a non-profit organization working to evaluate and endorse standardization of healthcare performance measures. Recently, NQF submitted a series of reports to the U.S. Department of Health and Human Services (HHS) outlining recommendations on new measures aimed at improving Medicaid beneficiary quality of care. For the last four years, NQF started providing strategies to HHS on improving care for dual eligibles, adults, and children in the Medicaid program. These new quality measures were created to improve healthcare quality for more than 70 million adults and children. The key area of concentration was the beneficiaries’ behavioral health and how it affects diabetic and cardiovascular care delivery.
In the reports, NQF tracked the effects behavioral health has on diabetics and the domino effect it has on a beneficiary’s overall health. Many providers are seeing that therapies used on patients with serious behavioral health issues are causing significant health problems. An example is weight gain as a side effect of the medications given to treat mental health illnesses. They saw this turn into health issues, such as diabetes, in these patients. The report continues to state that not addressing the behavioral health problems of a beneficiary has led to higher glycated hemoglobin (A1C) which then resulted in cardiovascular issues. This problem of addressing both the physical and mental health needs of the Medicaid population has been in the forefront of the American Psychiatric Association and U.S. Psychiatric and Mental Health Congress.
NQF has made recommendations for the working age population of adults, which are also the most rapidly-growing population relating to controlling and monitoring cardiovascular health (e.g., high blood pressure) and medication management in those individuals who have serious behavioral health illnesses. NQF has also made recommendations for children and dual eligibles. Due to the complex needs of the dual-eligible population, the amount of measures was increased, many concentrating on behavioral health and comorbidities. They also concentrated on making changes to the care coordination and readmission rate monitoring.
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