CMS scorecard leaves unanswered questions

By the CDHP team

In sports, scorecards can answer valuable questions about a team and its players. Beyond confirming a win or loss, they provide clues for what helped the team to victory. Which players performed well and which ones did not? Knowing these details can help a team plot strategies for improvement. Unfortunately, these helpful details are absent from the Medicaid and Children's Health Insurance Program (CHIP) Scorecard, which was recently released by the Centers for Medicare and Medicaid Services (CMS) to “increase public transparency about the programs’ administration and outcomes.”

At the Children’s Dental Health Project, we were particularly interested in the state health system performance section of the report. However, the measures reported in the scorecard are pulled from the child and adult core sets, both of which are reported elsewhere by CMS. Furthermore, reporting on these measures is voluntary for states and this limits the ability to compare data across states, as Georgetown University’s Center for Children and Families recently pointed out.

When it comes to oral health, the scorecard includes only one dental measure: the percentage of children receiving preventive dental visits. While this measure is a natural and important starting point, there is much this number does not tell about the impact of children’s coverage and the care they receive:

  • What happened during the typical dental visit?
  • What was the health status of each child and was it improved by the care they received?
  • Did they need follow-up care, and if so, did they receive it?
  • What about children who receive oral health services from pediatricians or other non-dental providers?

If our goal is to improve children’s oral health, overall health, and quality of life, this indicator provides little insight into how Medicaid and CHIP programs are accomplishing such outcomes.

The purpose of the scorecard itself is unclear. CMS Administrator Seema Verma has not provided any concrete expectations for follow-up based on scorecard performance. When pressed at a recent meeting with reporters, Verma offered few details. “The idea here is to give you a sense of where states are on different areas,” she said, adding that the scorecard could “be used for best practices.” But, by itself, a single utilization measure is unlikely to provide strong guidance to states on best practices.

We are unlikely to achieve that which we do not measure for. In other words, collecting and reporting the right kinds of data is crucial.

Elsewhere, through emphasis on new models of care and alternative payment approaches, CMS has demonstrated that improving oral health is, indeed, a priority. And we know from our work with a number of national stakeholders that moving beyond basic measures of service utilization is a long process requiring investments in new data systems, among other things. However, we also know that we are unlikely to achieve that which we do not measure for. In other words, collecting and reporting the right kinds of data is crucial.

Programs like Medicaid and CHIP have contributed to significant gains in oral health coverage and access to care for children. According to the American Dental Association’s Health Policy Institute, as of 2016 more children than ever have some form of dental coverage, and more than one-third of children receive those benefits from Medicaid and CHIP. We should be able to say with confidence that all of those children are receiving the care they need to thrive.

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Did you know?

75% }
of American Indian/Alaskan Native children have experienced caries by age 5.
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