Performance Measures

Metrics to Stimulate Quality Improvement

Since its beginning in 1998, CCNC has used performance measurement and feedback to help meet its goals of improving the quality of care for Medicaid recipients while controlling costs.  Quality measurement is intended to stimulate or facilitate quality improvement efforts in CCNC practices and local networks, and to evaluate the performance of the program as a whole. 

CCNC’s Quality Measurement and Feedback (QMAF) program was substantially expanded in 2009, in response to the needs of an expanded aged, blind and disabled enrolled population with multiple chronic conditions, and in response to requests from providers and practices to seek alignment in quality measures across multiple payer or stakeholder entities.  A workgroup with representation from all 14 CCNC networks was convened in 2007, and met over the course of a year for in-depth review of candidate measures.  Goals were to identify a broad set of quality measures with: 1) clinical importance (based on disease prevalence and impact, and potential for improvement), 2) scientific integrity (strength of evidence underlying the clinical practice recommendation; evidence that the measure itself improves care; and the reliability, validity, and comprehensibility of the measure), and 3) implementation feasibility, and 4) synergy with other state and national quality measures or quality improvement programs.  Measures are not intended to capture every aspect of good clinical care.

QMAF measures are reviewed on an annual basis, and final measures are approved by vote of the CCNC Clinical Directors.

General Notes on Chart Review Measures:

  •  Patients are eligible for inclusion in the sample by meeting disease criteria during the 12-24 months prior to the date of sampling, with at least 10 months of Carolina Access enrollment during the 12 months prior to sampling.  Charts are reviewed at the practice of the primary care provider assigned to the patient at the time of sampling.  The presence of the disease must be confirmed by chart review.
  • Patients with any of four qualifying condition (DM, asthma, HF, or Ischemic Vascular Disease) are eligible for the sample.  Sampled patients with multiple co-morbidities (including HTN) will be audited for all confirmed conditions. 
  • For CY 2010, a total of 53,685 patients from 1,332 practices were eligible for the sample.  20,000 patients were randomly selected for inclusion.  Network and Program-level performance rates are based on that random sample of 20,000.  Within CCNC practices that did not have patients selected among the 20K, an additional 7,052 patients were randomly selected for review, to allow for practice-level feedback in all 1,332 practices. 
  • All measures allow a one-year look back period from the date of the most recent office visit, unless otherwise specified
  • Practice-level results with patient-level detail available on a next-day basis.  Chart reviews will be conducted continuously over the course of the year.  Network- and Program- level reports, with internal and external benchmarks, will be published after all reviews are completed.

 General Notes on Claims-Derived Measures:

  • Claims measures will be reported quarterly
  • Patients will be included in claims-derived measures if:
    o Medicaid is the primary payer
    o Modified HEDIS disease definition criteria are met 12-24 months prior to end of reporting period
    o Patient is enrolled with CA 10 of 12 months prior to end of reporting period, and enrolled with PCP as of end of reporting perio
  • A “care alert” system allows providers access to continuously updated lists of currently enrolled patients in default of recommended services, as available in Medicaid claims data