How the Government, Payers May Start Judging Home-Based Care

Home- and community-based services could be better evaluated through quality measures in areas such as person-centered care and staff competency, an influential group has recommended to the Department of Health and Human Services (HHS).

HHS contracted the National Quality Forum (NQF) to identify gaps in home- and community-based services (HCBS) measurement and recommend how to address them. Those recommendations now have been put forward in a report issued Oct. 11. The National Quality Forum is a nonprofit organization whose members include hospitals, health systems, payers, patients, and other health care stakeholder groups. Both the federal government and private sector entities adopt NQF-endorsed quality measures, and nearly all NQF-endorsed measures are in use.

The pressure to have a more formalized way of measuring HCBS quality has mounted for various reasons, including new Medicaid managed care regulations requiring states to measure quality in certain areas. Health care reforms also have elevated the importance of HCHB providers, which offer personal care, food preparation, transportation and other services vital to aging-in-place and moving more care to the low-cost setting of the home.


The report identifies 11 domains to focus on in developing HCBS quality measures:

1. Service delivery and effectivness

2. Person-Centered planning and coordination


3. Choice and control

4. Community inclusion

5. Caregiver support

6. Workforce

7. Human and legal rights

8. Equity

9. Holistic health and functioning

10. System performance and accountability

11. Consumer leadership in system development

For each area, there are more specific concepts for measurement. For example, within “service delivery and effectiveness” there might be a measure for the total number of scheduled visits for each service type, by provider type, and the percentage that were on time, late, or missed.

While the report offers a framework for how states, payers, and other groups might implement measures, actually putting the infrastructure in place to do so and testing the measures will be “time and resource intensive,” the report’s conclusion notes. Indeed, the report is meant as a starting point.

“The goals of the domains and subdomains are to stimulate evidence-based research in support of quality measure development, guide quality improvement efforts, and highlight the important areas for measure development,” the report abstract states.

The recommendations were developed over two years by a group of stakeholders including providers, payers, caregivers, advocates, consumers, and others.

Written by Tim Mullaney

Photo Credit: “Hubert H. Humphrey Building – Washington, D.C.” by Tim Evanson, CC BY SA 2.0

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