This expert perspective reviews how Medicaid programs in Connecticut, Massachusetts and Rhode Island have engaged with commercial payers, providers, patients, advocates and other parties to create and adhere to multi-payer aligned measure sets. It describes the benefits to Medicaid agencies of participating in aligned measure set efforts, as well as tips and resources for Medicaid agencies intersted in measure alignment.
Considerations for State Development of Performance Measure Sets
Beth Waldman and Michael Bailit, Bailit Health Purchasing, LLC
As states play a more active role in health care delivery system and payment reform, Medicaid programs have joined other public and private sector purchasers in measuring performance as part of value-based purchasing initiatives. While essential to value-based purchasing, performance measurement can create a significant administrative burden for providers. This burden can grow significantly when individual payers (e.g., insurers, managed care plans, and third-party administrators) utilize different measures. There is a growing interest by Medicaid programs and other payers in developing common measure sets to reduce administrative burden on providers and send a common message to them about performance accountability. This guide provides an overview of the steps states should take in developing a performance measure set—either on their own or in partnership with others—identifies critical considerations, and offers guidance in selecting measures.