Writing a Good Outcome
States requesting enhanced Federal Financial Participation (FFP) for Medicaid Enterprise Systems (MES) should propose state-specific outcomes that demonstrate the successful achievement of the MES project, confirm the system functionality, and show benefit to the Medicaid program. State-specific outcomes should target achieving improvements to distinct business, operational, or policy challenges that produce direct benefits to the Medicaid program. These outcomes should respond to the unique needs of a state’s Medicaid program and represent operational improvements not specifically addressed by the CMS-required outcomes.
A good state-specific outcome helps a state monitor the desired functionality and efficiency of its Medicaid program and operations. States should collaborate with their CMS State Officer to finalize state-specific outcomes that comply fully with Medicaid statutes and regulations, as well as a set of metrics that assure a practicable assessment of the proposed module’s effectiveness. States can draw on the process and considerations in this document to write good state-specific outcomes and determine effective metrics for their measurement and assessment.
Identify the State-Specific Outcome
To begin, states should (1) clearly define the primary objective of their MES project initiative and (2) focus on the desired result that addresses the state’s specific challenge or need.
Examples:
- “Increase the number of Medicaid patients who can schedule appointments online.” The target of this outcome is improving patient access to scheduling services, which addresses current issues with accessibility and convenience.
- “Expand the provider directory of active Medicaid providers, ensuring accurate and up-to-date information.” This outcome focuses on expanding and maintaining the accuracy of the provider directory. The successful result helps assure adequate capacity to serve expected enrollments in a given service area while maintaining a sufficient number, mix, and geographic distribution of providers.
Checklist
The table below presents a checklist for a state’s approach and considerations for drafting good state-specific outcomes.
| Step | Action | Things to Consider |
|---|---|---|
| 1 | Align with Medicaid Program Goals | - State-Specific Goals: Review the state’s Medicaid plan and identify key goals such as improve patient care, reduce costs, or enhance system efficiency. - CMS Requirements: Ensure that the business outcomes align with CMS-required outcomes for compliance. |
| 2 | Define Clear and Specific Business Outcomes | - Target Specific Problems: Identify the state’s specific issues or needs for the MES project. - Desired Results: Articulate how the state’s success produces specific results. |
| 3 | Ask the “So What” Question | - A measurable outcome delivers more than data points for leadership’s assessment; a successful outcome represents actual benefits in economy, effectiveness, and efficiency for the state and the Medicaid program in general. - Operational Efficiency: Evaluate how the proposed outcome will streamline processes, reduce waste, and improve the overall efficiency of Medicaid operations. |
| 4 | Focus on Measurable Metrics | - Quantifiable Metrics: Choose metrics that can be easily measured and tracked over time. - Baseline Data: Establish current performance levels against which to measure improvement. |
| 5 | Consider Stakeholder Impact | - Patient Benefits: How will the project improve patient outcomes? - Provider Benefits: How will the project benefit healthcare providers? |
| 6 | Ensure Goals are Feasible and Realistic, Focusing on Quality Over Quantity | - Achievable Goals: Set realistic goals that can be achieved within the project timeline and budget. - Quality Over Quantity: Identify impactful metrics, not a large quantity of random information. - Resource Availability: Consider the resources available, including technology, staff, and funding. |
| 7 | Incorporate Continuous Improvement | - Feedback Loops: Include mechanisms that promote ongoing feedback and continuous improvement. - Scalability: Ensure the business outcomes can be scaled or adapted as the project evolves. |
| 8 | Use Clear and Concise Language | - Avoid Jargon: Use plain language that is easily understood by all stakeholders. - Be Specific: Avoid vague statements. |
| 9 | Reassess State Needs and Update as Needed | - Reassess: Reevaluate state-specific outcomes and metrics periodically to ensure continued relevancy. - Update: Once goals have been achieved, modify, archive, and/or add new metrics that meet current state and CMS needs. |
Determine Metrics (Data) that Show the Achievement of State-Specific Outcomes
Once a state establishes its state-specific outcome statement for a desired module, it needs supporting metrics to measure the intended state-specific outcome. Metric data is the evidence that shows how the state accomplishes its state-specific outcomes on a continuous basis. Well-designed metrics enhance transparency and accountability of information technology systems, provide insight for efficient program evaluation and/or retirement of specific outcomes, and reveal opportunities for continuous improvement.
In determining relevant metrics to measure state-specific outcomes, states should consider:
- What quantifiable metrics demonstrate that a module or system meets the desired state-specific outcome?
- How do the specific metrics help us assess the program results?
- What is the current baseline?^
Examples:
- “Average time to screen a provider.”
- “The number of Emergency Room and hospital readmissions.” (In relation to an outcome of increasing preventive care services.)
- “The percent of patient engagement within 30 days by their community care team after discharge.”
^ Please note that CMS does not currently require measurable benchmarks. However, states are encouraged to measure their progress in attaining state-specific outcomes should they wish. Setting a timebound benchmark establishes a clear, measurable target for improvement, making it easy to track progress and adjust as necessary. It also allows states to determine whether they have met their state-specific outcomes, in which case, these can be retired and new metrics identified for measurement.
For more information or to share your state-specific outcomes and metrics, please contact your CMS State Officer or email MES@cms.hhs.gov.