Oregon Approves Use of AHRQ Prevention Quality Indicators for its Medicaid Program
As a result of attending the January 2008 AHRQ State Healthcare Quality Improvement Workshop—sponsored by AHRQ's Knowledge Transfer Quality Diagnostic Tools for States project—Oregon officials decided to use the Preventable Hospitalization Costs and Mapping Tool and Prevention Quality Indicators (PQIs) as part of their analysis of disparities within the Oregon Medicaid program. As a result of this analysis, the Oregon legislature approved the use of AHRQ's PQIs as the benchmarks for the State Medicaid program.
This process began in the summer of 2008, when the Oregon State legislature assigned Charles Gallia, PhD, Manager of Research and Analysis, Medical Assistance Programs for the Oregon Department of Human Services, and his office the task of determining the cost of disparities throughout the State's Medicaid program. To undertake this analysis, Gallia looked for a benchmark at the State level, and then at the sub-State level.
Gallia recalled the Preventable Hospitalization Costs and Mapping Tool, which was showcased at the AHRQ State Healthcare Quality Improvement Workshop. The AHRQ workshop presented information on the Preventable Hospitalization Costs and Mapping Tool and the PQIs, along with other AHRQ products and tools that diagnose quality issues and improve the quality of care. The Preventable Hospitalization Costs and Mapping Tool enables use of the PQIs in performing comparisons at the sub-State level.
In addition to generating maps, Gallia took the SAS codes from the Preventable Hospitalizations Cost and Mapping Tool and used them to run his sub-State comparisons. He identified PQIs that had higher rates of disparities and identified different parts of the State that were paying more for these disparities. Gallia believes the Preventable Hospitalization Costs and Mapping Tool was critical in performing this analysis, because "it eliminated geographically based issues as opposed to payer-type and allowed analysts to control for access issues. The tool is really relevant and useful to the work we are doing in Oregon."
Gallia presented the results of his analysis to the Oregon State legislature, which resulted in multiple follow-up questions. He then used the AHRQ tool to disaggregate Oregon's data at the county level and created a disparity map of Oregon by county and by condition. The county-level information was presented to Oregon's Medicaid plans and community representatives to elicit their suggestions for addressing the identified disparities. The Medicaid plans were pleased to be a part of the process in determining steps to address disparities on Oregon.
The revised analysis was then presented to the State legislature, which accepted the report and the use of AHRQ's PQIs for benchmarking as part of Oregon's overall effort to provide high-quality, cost-effective care to Oregon Medicaid participants.