Performance Measurement

Federal Medicaid regulations require state programs to continually monitor and assess the quality of care provided to clients. Since 2001, UMass Medical School’s Center for Health Policy and Research has assisted MassHealth, the state’s Medicaid program, by

  • Monitoring performance and client satisfaction,
  • Identifying opportunities for improvement, and
  • Assisting with the design of improvement activities.

One of the most visible results of this assessment is the Health Plan Employer Data and Information Set (HEDIS) report, which is produced annually by the Center for Health Policy and Research. The HEDIS tool is used by 90 percent of health care plans in the U.S., providing a ready way to compare MassHealth data with national benchmarks in 71 areas across eight domains of care. The report breaks downs how the MassHealth program performs compared with other Medicaid programs nationwide. For the 2007 report, for example, MassHealth managed care plans did better than 75 percent of all Medicaid plans on many of the measures.

Focused Studies

Periodically, UMass Medical School’s Center for Health Policy and Research conducts in-depth reviews of selected clinical topics for the MassHealth program. The Clinical Topic Reviews are often completed in two stages. In the first stage, initial data is collected to serve as a benchmark. Several years later, the study is repeated to assess any progress and identify areas for improvement.

The 2008 Clinical Topic Review focuses on behavioral health screenings for children and adolescents. The project will attempt to answer the following questions:

  • Are children and adolescents routinely screened for behavioral health conditions?
  • Are providers using standardized behavioral health screening tools?
  • If so, what standardized screening tools are being used?
  • What percentage of members screened positive, and what percentage of members had already been identified with a behavioral health condition?
  • Were youths referred to treatment? If so, where they were referred for treatment, and what kind of treatment was provided?

Past Clinical Topic Reviews:

  • Childhood immunization
  • Perinatal care and postpartum depression
  • Cervical cancer screening
  • Diabetes care
  • Developmental health care
  • Children with special health care needs and depression

 

Key Staff

Ann Lawthers  Ann Lawthers, S.M., Sc.D.
Senior Director, Evaluation and Measurement, and Director, Clinical Policy and Projects
   

Learn More

David Tringali
(617) 210-5423
david.tringali@state.ma.us