In September, the National Quality Forum (NQF) released their final report Quality in Home and Community-Based Services to Support Community Living: Addressing Gaps in Performance Measurement which looks at ways to measure the quality of various home and community-based services (HCBS) across the country.
NQF Report Strives to Measure HCBS Quality and Track Improvements
According to the report, “more than 12 million Americans need long-term services and supports (LTSS), a figure that is expected to increase to 27 million by 2050.” Most of these individuals are currently receiving unpaid help with their daily activities and only a fraction receive paid services funded by government sources like Medicaid. Of the 12 million people in need of LTSS, the report found that only “3 million people receive Medicaid-funded home and community-based services (HCBS),” although the report notes that this figure “is expected to increase rapidly with the aging of the population and a continued shift away from institutional LTSS.”
With little information collected to date about HCBS quality, one of the goals of the NQF is to stimulate more evidence-based research that will develop and support ways to measure quality, and track improvements across home and community-based services (HCBS), so that people who use HCBS can ensure they are receiving the best services possible.
Barriers and Challenges to Measuring HCBS Quality
Measuring the quality of the various home and community-based services in America is no easy task. The NQF noted the following barriers and challenges to measuring HCBS quality:
- “Lack of standardized measures across the country, which is exacerbated by the decentralized nature of the HCBS system;
- Lack of or limited access to timely data on HCBS programs;
- Variability across the numerous federal, state, local, and privately funded programs with respect to reporting requirements and the flexibility offered to states and providers to establish their own quality measures to meet requirements;
- The added administrative burden of data collection, management, reporting, and incorporation into quality improvement activities.”
With these barriers in mind, the NQF made recommendations around 11 areas (referred to as domains) for measuring the quality of HCBS including:
- “Developing and implementing a standardized approach to data collection, storage, analysis, and reporting;
- Developing a core set of standard measures for use across the HCBS system, along with a menu of supplemental measures that are tailorable to the population, setting, and program.”
Recommendations for Measuring HCBS Quality
- Service delivery and effectiveness
- Person-centered planning and coordination
- Choice and control
- Community inclusion
- Caregiver support
- Human and legal rights
- Holistic health and functioning
- System performance and accountability
- Consumer leadership in system development
For each of the above areas, the NQF report broke recommendations into three main categories, including:
- Short-term recommendations (for areas where there are existing measures or measure concepts that have been tested or could be tested in HCBS populations)
- Intermediate recommendations (for areas where there are some existing measures or measure concepts, but more development is required)
- Long-term recommendations (for areas where there are few or no measures or measure concepts, and more research is needed)
What This Means for the HCBS Workforce and Individuals Who Use HCBS
The recommendations are centered around ways that quality can be identified, measured, tracked and improved across the 11 areas mentioned above. According to Steven Ross Johnson, a public health journalist for Modern Healthcare, examples of these measurements of quality include “measuring the ability of patients to make their own choices regarding the support they receive, the level of support made available to caregivers, and the degree to which a provider’s workforce is adequately paid and trained.”
Eventually, these recommendations could provide individuals who use home and community-based services as well as the government and HCBS workforce with ways to compare and contrast services and advocate for improvements. At this point, how the government will act on the NQF report’s recommendations remains to be seen.
How do you think these recommendations will impact home and community-based services? Do you think it’s important to quantifiably measure quality? Why or why not? Share your thoughts with us in the comments below.