Medicaid is the health care safety net for low-income adults, mothers, and children; individuals with disabilities; and low-income elders. Due to the current economic downturn, State Medicaid rolls are rapidly expanding. Yet Federal and State budgets are shrinking, forcing State Medicaid medical directors to wrestle with tougher challenges.
The Agency for Healthcare Research and Quality (AHRQ) began funding the Medicaid Medical Director's Learning Network (MMDLN) in 2005 to provide a forum for medical directors to address evolving challenges and hear about solutions that may work in their State or could be adapted for their State. We were also interested in learning from them where AHRQ research investments were most needed to improve quality and value for Medicaid beneficiaries.
In the MMDLN, medical directors discuss mutual problems and agree on which ones they have the resources to tackle. In many cases, States that have data on a problem and the staff to analyze it form a group to look at the problem, like the 16 States who examined rehospitalization rates discussed in the cover story.
The medical directors use research evidence from these State studies, AHRQ patient-centered outcomes research, and AHRQ data sources such as the Health Care Cost and Utilization Project (HCUP) to change practices and inform policy decisions.
For example, individual States can use data from HCUP to identify which hospitals in their State have higher readmission or c-section rates to pinpoint where improvements are needed. They can find out approaches to reduce those rates through MMDLN discussions and resources. In some cases, the solution can be a policy change; in others, it may be a change in care delivery or coordination. The goal is better, more efficient and appropriate care for our most vulnerable citizens.
Carolyn M. Clancy, M.D.
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