Outcome Measurement Program Case Studies

Policy Context

The Centers for Medicare & Medicaid Services (CMS) along with state Medicaid agencies fund Home and Community-Based Services (HCBS) in all states.  Medicaid-funded HCBS are the primary publicly funded resource for individualized long-term services and supports (LTSS), enabling more than three million people who are aging and with disabilities to live in their communities.  HCBS enable individuals, including those with age-related support needs and those with physical, cognitive, or other disabilities, needing LTSS to experience the same access to and opportunities for social, civic, career, educational, and home life as their peers without disabilities.  CMS implemented new HCBS regulations in 2014 . It will be important to determine if the 2014 rule change improves outcomes for people receiving HCBS-funded LTSS.  To accomplish this, it is essential to accurately assess HCBS impact and make improvements when needed. 

Measurement Program

The Council on Quality and Leadership (CQL) developed a measure of 21 quality of life (QOL) indicators clustered into five categories, the Personal Outcome Measures® (POM).  The CQL maintains a robust program of training and certifying interviewers, providing technical assistance, and measurement development processes that ensure validity and reliability. The original measure was developed in 1992 (Gardner, Carran & Nudler, 2001).

Key Messages   

Strengths of instruments like the POMs®in HCBS outcome measurement:

1. Focusing attention on important life outcomes in measurement is essential in order to assure that stakeholders pay attention to those outcomes when funding, planning, providing, and evaluating supports.
2. The use of well-designed (reliable and accurate ) outcome measures is critical in decision-making by providers and staff when supporting HCBS outcomes of individuals with disabilities.
3. Models of person-centered services and supports can be shared across organizations on a local, regional, or statewide basis to promote a common vocabulary and evidence of HCBS outcomes.
4. Analytic tools that provide person-level data reports as well as mechanisms for aggregating results can be useful in identifying systemic patterns of program strengths and challenges.

Challenges of instruments like the POMs® in HCBS outcome measurement:

1. Requires initial and periodic training and recertification of interviewers to assure standardized and reliable results that can lead to decisions that are specific and replicable.
2. Offers its greatest potential when direct support staff are engaged in the process, which can be difficult given the endemic high turnover and vacancy rates among direct support staff.
3. A selected set of outcome areas may not cover all domains identified by the National Quality Forum (NQF; 2016).
4. While there is some capacity to use the tool for inferential statistical  analysis, constructing samples, and arranging for interviewing representative samples can present logistical challenges.