Quality of Care

Quality care is generally considered to be that which is safe, effective, patient-centered, timely, equitable, and reliable (IOM 2001). At the system level, quality improvement efforts should focus on receipt of the right care, at the right time, in the right setting, all the time (HHS 2011). Ultimately care should be provided that leads to the best outcomes for patients—improvement in health, maintenance of function, and for patients who are in declining health, appropriate and effective care and supportive services that improve quality of life.

Medicaid and CHIP programs engage in quality improvement through delivery system design, payment incentives, and holding plans and providers accountable for desired quality and cost outcomes. States are increasingly incorporating quality measures into their payment and purchasing strategies. They set quality standards in managed care contracts and create incentives for plans to meet targets for improvements in the process and outcome of care, and in the patient experience.

The Centers for Medicare & Medicaid Services (CMS) disseminates findings from state quality reporting in the Medicaid and CHIP Scorecard, and in the annual Child and Adult core set chart pack reports. CMS has also developed quality initiatives and performance measure sets for specific populations and conditions, including behavioral health, maternal and perinatal health, and long-term services and supports (LTSS).