Assisted by expert consultants, this effort emphasized the findings of the Schizophrenia Patient Outcomes Research Team and allowed the team to create concepts for new measures that assess the quality of medication management, underuse of evidence-based psychosocial treatments, and access to primary care and preventive health services. The project began with a review of existing literature and other evidence describing evidence-based practices for people with schizophrenia. The goal of the project was to create a set of claims-based ambulatory care measures that meet National Quality Forum (NQF) criteria for importance, scientific acceptability, usability, and feasibility and would thus be suitable for submission to the NQF for endorsement consideration. Department of Health and Human Services Office of the Assistant Secretary for Planning and Evaluation (ASPE) contracted with Mathematica Policy Research and its subcontractor-the National Committee for Quality Assurance-to develop evidence-based quality measures to assess the quality of care provided to Medicaid enrollees diagnosed with schizophrenia. National Institute for Health and Clinical Excellence National Association of County Behavioral Health and Developmental Disability Directors Medicaid Medical Directors Learning Network Managed behavioral healthcare organization Institute for Clinical Systems Improvement Healthcare Common Procedure Coding System New Hampshire Department of Health and Human Services Office of the Assistant Secretary for Planning and EvaluationĬenters for Medicare and Medicaid Services They address the following concepts: use of antipsychotic medications, antipsychotic medication possession ratio, diabetes screening, diabetes monitoring cardiovascular health screening, cardiovascular health monitoring cervical cancer screening, emergency department utilization for mental health conditions, and follow-up after mental health hospitalization within seven days and within 30 days. Ten measures were pilot tested using MAX data. The psychosocial treatment measure was dropped because procedure codes used in claims data are ambiguous, lacking sufficient detail to reflect the actual service provided and these codes are not used consistently in different states and programs. The purpose of this project was to identify, specify, and test at least three measures that address pharmacological treatment, psychosocial treatment, and physical health needs for individuals with schizophrenia that can be calculated solely from Medicaid claims data. Quality measures can help achieve the full promise of these reforms by providing feedback to payors and providers and enabling greater transparency and accountability. Health care reform promises to make insurance benefits newly available to many, eliminate inequitable treatment limits and financial requirements, and promote integrated primary and behavioral health care. Despite enormous expenditures and innovations in treatment, the United States health care system does not consistently deliver effective treatment to individuals with serious mental illnesses.
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