Quality Strategy and Measurement

Buying value requires measuring it. A purchaser that cannot see quality can only buy on price, which in Medicaid means buying the cheapest plan rather than the best one. Two requirements give the agency something to buy on.

The required quality strategy

Every managed care state must maintain a written quality strategy under 42 CFR 438.340: a public document setting its goals, the measures it will track, and how it will hold plans accountable. The quality strategy is where the abstract goal of “value” becomes specific targets a plan can be scored against, and it ties directly to the procurement leverage from the previous lesson.

Newly mandatory measurement

For most of Medicaid’s history, quality reporting was voluntary and uneven, which made cross-state comparison nearly impossible. That changed recently. Under the SUPPORT Act, reporting of the Child Core Set and the behavioral health measures on the Adult Core Set became mandatory beginning in federal fiscal year 2024 for all states, the District of Columbia, and the territories.

Worth remembering: mandatory Core Set reporting is a quiet but real shift. When every state must report the same standardized measures, a national picture of Medicaid quality becomes possible for the first time, and states can finally be compared, and hold their plans accountable, on a common yardstick.

The measurement caution still applies

Everything the intro course said about measurement carries over. Mandatory measures can be reported and ignored; a plan can hit its numbers without improving care; process measures can crowd out the outcomes that matter. Standardized reporting is necessary infrastructure, not a guarantee of quality. It gives the purchaser a yardstick; using it well is a separate skill.

Key takeaways

• Managed care states must maintain a written quality strategy (42 CFR 438.340) defining goals, measures, and accountability.
• The SUPPORT Act made Child Core Set and adult behavioral-health measure reporting mandatory from FFY 2024, enabling national comparison.
• Standardized measurement is necessary infrastructure but does not by itself produce quality.

Sources

• Medicaid.gov, Child and Adult Health Care Quality Measures (opens in a new tab)
• Federal Register, Mandatory Medicaid and CHIP Core Set Reporting (2023) (opens in a new tab)