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Medicaid Performance Measures

Performance measures are designed to show how a program is doing.  The Department of Vermont Health Access (DVHA) runs many measure sets to see how Medicaid is working. DVHA displays performance measure results in scorecards. Scorecards are visual tools that display data and explain trends all in one place. Below are some examples.  (When viewing a scorecard, click the plus symbol to the left of the performance measure you would like to see.)

  1. Federal legislation called for the creation of core sets of healthcare quality measures to assess the quality of care for adults and children enrolled in Medicaid. The U.S. Department of Health & Human Services established the Adult and Child Quality Measure Core Sets to standardize the measurement of healthcare quality across state Medicaid programs, assist states in collecting and reporting on the measures, and facilitate use of the measures for quality improvement. DVHA reports these measure sets to the Centers for Medicaid and Medicare Services (CMS) on an annual basis. 
    View the Adult Core Set Scorecard 
    View the Child Core Set Scorecard
  2. Starting In 2005, the Legislature approved Vermont to participate in a Medicaid waiver called the Global Commitment to Health Waiver.  The waiver is still in place today and allows DVHA flexibility with the use of Medicaid dollars. This flexibility allows DVHA to approve benefits, explore performance-based payments, and be innovative in program developments. The waiver is based on a managed care model which requires the Agency of Human Services (AHS) to oversee the DVHA quality program.

    DVHA reports Global Commitment Measures to show how the waiver is doing to AHS.  AHS also requires that an external quality review organization confirm that these measures have been run correctly.  
    View the Global Commitment to Health Scorecard

Here is a list of the performance measures in the Global Commitment to Health Scorecard:

Global Committment Waiver Measures
 

Focus Area: Prevention and Screening

Performance Measure:

  • Adult Body Mass Index Assessment (ABA)
  • Breast Cancer Screening (BCS)
  • Chlamydia Screening in Women (CHL)
  • Developmental Screening in the 1st 3 Years of Life (DEV)
  • Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents (WCC)

Focus Area: Utilization

Performance Measure:

  • Well Child Visits in the First 15 Months of Life (W15)
  • Well Child Visits in the Third, Fourth, Fifth, and Sixth Year of Life (W34)
  • Ambulatory Care Emergency Department Visits (AMB)
  • Adolescent Well-Care Visits (AWC)

Focus Area: Access/Availability of Care

Performance Measure:

  • Annual Dental Visits (ADV)
  • Initiation and Engagement of Alcohol and Other Drug Dependence Treatment (IET)
  • Adults’ Access to Preventive/Ambulatory Health Services (AAP)
  • Prenatal and Postpartum Care (PPC)

Focus Area: Behavioral Health

Performance Measure:

  • Follow-Up After Hospitalization for Mental Illness (FUH)
  • Follow-up after ED for Alcohol and Other Drug Dependence (FUA)
  • Follow-up after ED for Mental Illness (FUM)

Focus Area: Diabetes

Performance Measure: Comprehensive Diabetes Care (CDC)


Focus Area: Respiratory Conditions

Performance Measure: Asthma Medication Ratio (AMR)


Focus Area: Cardiovascular Conditions

Performance Measure: Controlling High Blood Pressure (CBP)


Focus Area: Long Term Services and Supports

Performance Measure: Various National Core Indicator (NCI) survey measures