Iowa Medicaid Enterprise
As a result of attending an AHRQ Knowledge Transfer Program workshop highlighting State health care quality improvement tools, the Iowa Medicaid Enterprise is using Healthcare Cost & Utilization Project (HCUP) data in an initiative called the Medicaid Value Management Program to maximize the value of its Medicaid program.
The goal of the Medicaid Value Management Program is to determine whether the quality of care for the Iowa Medicaid Enterprise membership falls within the average of other states participating in HCUP. This analysis will allow the identification of quality indicators needing improvement and show where to focus efforts.
The Medicaid Value Management Program is using the Prevention Quality Indicators, Inpatient Quality Indicators, and Pediatric Quality Indicators to establish confidence intervals—a statistical measure of a range of values associated with a percentage value. A 95 percent confidence interval means that there is a 95 percent probability that the target value will fall within the given range.
The Iowa Medicaid Enterprise is an endeavor uniting staff in the State of Iowa and private contractors in a performance-based model for administration of the Medicaid program. Even though the Iowa Medicaid Enterprise team was familiar with HCUP and HCUPnet prior to attending the 2007 workshop in Philadelphia, the workshop illustrated compelling examples of how the tool could be used and provided more information on the underlying data—both of which facilitated the team's actual use of HCUP. After the workshop in Philadelphia, this team decided to leverage data from HCUP to support comparison efforts in the Medicaid Value Management Program.
"We used AHRQ SAS code [contained in HCUP] to calculate the Prevention and Inpatient Quality Indicators. The SAS code comes with excellent instructions and is easy to set up and modify for our use," says Thomas Kline, DO, Medicaid Medical Director of the Iowa Medicaid Enterprise. The Medicaid Value Management team will continue to review and monitor the results of Prevention Quality Indicators data on a quarterly basis to track changes and alter its strategies.
The Iowa Medicaid Enterprise team hopes to use the Medicaid Value Management program not only to provide cost-effective, quality health care for its members, but also to suggest policy changes to the legislature.
Impact Case Study Identifier: KT-CDOM-12
Healthcare Cost & Utilization Project—Prevention Quality Indicators, Inpatient Quality Indicators, Pediatric Quality Indicators (HCUP-PQIs, IQIs, PDIs), Quality Diagnostic Tools for States, HCUPnet
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