Federal Policy
CMS Launches Quality Partnership With 37 States to Shift Medicaid Measures Toward Health Outcomes
CMS announced a new quality measurement partnership with 37 states to refocus Medicaid quality metrics on health outcomes rather than process measures. The initiative launches immediately and will develop and test outcome-based measures over the next 18 to 24 months. The shift affects how state Medicaid agencies and managed care plans will be evaluated for quality performance, requiring changes to quality strategies, managed care contracts, and potentially capitation rate methodologies. States participating in the partnership will pilot new outcome measures before broader adoption across the Medicaid program.
Why it mattersThis signals a major shift in how CMS will evaluate Medicaid quality performance, requiring state agencies and MCOs to redesign quality measurement frameworks, contract terms, and potentially value-based payment arrangements around health outcomes rather than traditional process metrics.
Also covered by:aha.org