The fragmentation of the current healthcare system makes it difficult to measure quality among the dual-eligible population, according to a new report.

Provisions of the Affordable Care Act require the Department of Health and Human Services to join forces with the public-private National Quality Forum to improve the quality of care for the largely elderly and disabled individuals who receive both Medicare and Medicaid benefits. But the current lack of coordination between the two agencies makes it almost impossible to capture data for the total cost of care for this group, according to an interim report from NQF.

The report recommends five measures HHS should focus on: quality of life, care coordination, screening and assessment, mental health and substance abuse, and structural measures.