Illinois Uses AHRQ Tools to Improve Medicaid Measurement
Illinois Healthcare and Family Services refined its Medicaid care management program's measurement strategy to better reflect program interventions as a result of participating in the Medicaid Care Management Learning Network, an AHRQ Knowledge Transfer program. The Learning Network serves State Medicaid agencies that operate care management programs for chronically ill beneficiaries in fee-for-service plans or primary care case management programs. The Illinois Medicaid program is one of 17 States participating in this Learning Network.
The Learning Network provides expertise to participating States in four key areas critical to ensuring a quality-driven care management program:
- Helping patients become active in their care.
- Encouraging provider participation in care management programs.
- Creating program interventions aligned with the State's measurement strategy that will impact patient care.
- Designing valid and reliable evaluations to determine program success.
As part of its contract with a disease management vendor, McKesson Health Solutions, Illinois Healthcare and Family Services sets forth certain financial and quality goals. If McKesson fails to achieve the specified goals, a percentage of the fees the State paid are returned.
At the State's request, the AHRQ project team provided program recommendations based on AHRQ's publication, Monitoring and Evaluating Medicaid Care Management Fee-For-Service Programs: A User's Guide. As a result, Illinois officials moved forward with steps to refine its measurement strategy and alter financial and quality goals. For example, State staff refined the evaluation of program strategies using a stronger research methodology to better understand which strategic approach seems to yield the greatest benefit.
Another way Illinois officials refined the measurement strategy was by changing the approach to analyzing data reports. Instead of focusing on average values only, State staff examine the full distribution of data points related to a measure as well as overall trends. By looking at the range, they have a better perspective on what is happening over time and can assess whether particular interventions can influence the outliers. Looking at the entire range of data also allows them to see change more quickly.
The Learning Network has supported the State's ability to show benefit from their disease management efforts. Mary Miller, Disease Management Program Manager, Illinois Healthcare and Family Services, says, "We found the discussions and technical support to be invaluable. Participation [in the Learning Network] has helped Illinois staff understand many complex aspects of a statewide disease management program, including the importance of and strategies for effective outreach, designing and delivering a value-added message to stakeholders, financial reconciliation as a process, and consideration of implementing an incentive program. The Learning Network introduced us to the pay-for-performance concept and gave us some previously unknown considerations for the evaluation of our program."
The Illinois disease management program began in July 2006 and focuses on the following populations:
- Aged, blind, and disabled members.
- Members who have persistent asthma.
- Members who have visited the emergency room more than six times in the past 12 months without a subsequent hospital admission.
Illinois contracts with McKesson Health Solutions to administer the disease management program for more than 250,000 eligible members. Services provided to members include a 24/7 call center, telephonic and nurse care management, and educational materials. Community-based teams composed of nurses, social workers, pharmacists, behavioral health specialists, and lay educators deliver in-person care management services within 24 geographic regions in the State.
For more information on the Learning Network, go to: http://www.ahrq.gov/qual/medicaidmgmt/