New CMS Medicaid-CHIP Scorecard Creates a Pivotal Moment for Public Health Partnership

June 21, 2018|1:18 p.m.| ASTHO Staff

On June 4, 2018, the Centers for Medicare and Medicaid Services (CMS) released a new scorecard that may serve as a new opportunity for state/territorial health agency (S/THA) leadership to collaborate with Medicaid agencies, especially at this early phase of development. The new scorecard combines quality metrics and collectively measures the Children’s Health Insurance Program (CHIP) and state Medicaid programs. CMS intends for the scorecard to be a tool for states to learn from high-achieving peers and contribute to the development of best practices; however, a great deal of uncertainty remains around the scorecard’s use and general reliability. S/THA leadership may consider this as an opportunity to fulfill the role of chief health strategists and partner with their sister Medicaid agencies to jointly improve population health and quality measures, as well as to engage in broader joint strategic planning and priority setting.

The CMS scorecard includes measures voluntarily reported by states and federal metrics that span across three categories:

  • State Health System Performance: This category measures effective communication and coordination of care, reducing harm caused in the delivery of care, promotion of effective prevention and treatment of chronic diseases, strengthened engagement in care, affordability of care, and engagement with communities to promote best practices of healthy living.
  • State Administrative Accountability: This category illustrates state accountability for how the states and federal government are performing administratively. This measures the timeliness of states to submit information on State Plan Amendments and 1915 waivers, timing of state submissions on the Managed Care Capitation Rate Review, and expenditures on Home & Community Based Services as a percentage of total spending on long-term services and supports.
  • Federal Administrative Accountability: This category illustrates federal accountability for the state-federal relationship by measuring the timeliness of CMS review of State Plan Amendments, 1915 waivers, Managed Care Capitation Rates, and the Section 1115 Demonstration approval process.

CMS will update the scorecard annually with new metrics and will aim to increase consistency between states’ reporting. For example, future scorecards may assess Medicaid community engagement requirement programs, such as tracking how many people are working, in job training, or going to school. However, the federal agency has not explicitly shared how this scorecard will be used in the future once more consistent data becomes available.

The Center for Children and Families at Georgetown University has raised concerns that the State and Federal accountability categories place too much emphasis on timeliness and efficiency, could undermine a focus on improving the health of beneficiaries and misalign incentives for Medicaid agencies to focus on quality of care. The center has also suggested the development of the scorecard would have benefited from more stakeholder inclusion and that future iterations of the scorecard should have ample time for feedback.

The National Association of Medicaid Directors has emphasized that this scorecard does not account for differences between state’s covered Medicaid populations or care delivery structures and has argued that the scorecard does not provide much needed, meaningful context. Yet, due to the nature of the “scorecard” format, this product will inevitably invite comparisons between states and at least imply that some state Medicaid programs are performing better than others.

As it currently stands, the Administration emphasizes that the scorecard is not intended to be used for state-by-state comparisons due to variability in data availability, such as differences in data available for populations covered under fee-for-service and for those in managed care.

CMS has suggested that future measures may also focus on how well Medicaid agencies work with communities to provide support for healthy living among individuals receiving long-term care serviced.  The Scorecard may also assess Medicaid community engagement requirement programs, such as tracking how many people are employed, in job training or going to schools.  Such measures could also be utilized to measure place-based initiatives.  For example, consider how Colorado’s Office of the Governor, Medicaid agency, and Department of Public Health and Environment convened a policy academy to leverage existing regional care collaborative organizations to provide targeted care coordination at the community level for the highest utilizers of healthcare resources, paid for through a per-member-per-month payment. Performance measures included rates of postpartum care completion, reduced hospitalization, and well-child visits – all of which overlap with the CMS scorecard metrics.