New York Uses AHRQ Tools to Evaluate Pilot Medicaid Program

Prevention and Care Management

2009

The New York Department of Health's participation in the Medicaid Care Management Learning Network, an AHRQ Knowledge Transfer project, was instrumental in developing evaluation strategies for the State's disease and care management programs. The Learning Network was also influential in designing components for a new chronic illness demonstration project for medically and behaviorally complex beneficiaries. 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. New York is one of 17 States participating in the Learning Network.

Through AHRQ's Knowledge Transfer Program, 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.

For New York's care management demonstration programs, AHRQ provided technical assistance on evaluating the State's programs during calls with New York State officials, workshops, and a site visit. The AHRQ-supported Learning Network workshops and AHRQ's publication, Monitoring and Evaluating Medicaid Fee-For-Service Care Management Programs: A User's Guide, provided New York staff with an overview of the importance of program evaluation, including aligning measures with interventions and reviewing evaluation methods (e.g., random-control trials versus pre/post tests).

In addition, AHRQ staff and publication provided recommendations on the following:

  • Setting clinically meaningful measurement goals.
  • Measuring patient satisfaction.
  • Conducting medical record reviews.
  • Measuring medication adherence.
  • Understanding how members entering care management programs during varying phases are different from one another.

By incorporating AHRQ's recommendations, New York staff developed a more robust program evaluation strategy to determine impact of the demonstration programs on the cost and utilization of health care services.

AHRQ's Learning Network also made an impact on New York's program design and planning for new chronic illness demonstration projects. The agency's technical assistance helped State officials identify both lessons learned and successful components of care management programs. Many of these components were incorporated into the design of the new chronic illness demonstration projects.

For example, the AHRQ project team created a logic model of the care management demonstration program. This model displayed program inputs, program activities and services, outputs, and short- and long-term outcomes, all of which assisted New York officials in selecting successful interventions for the chronic illness demonstration projects.

The New York Team notes that the logic model displayed information about the program, which was helpful in sharing with others not familiar it. They also say that the process facilitated by AHRQ helped them identify program successes easily.

New York began operating six different care management demonstration programs in 2006 to test new and innovative strategies to manage complex health needs and enhance the care of chronically ill Medicaid patients. Each demonstration program focuses on different chronic conditions including mental illness, chronic kidney disease, end-stage renal disease, asthma, diabetes, coronary artery disease, congestive heart failure, and chronic obstructive pulmonary disease.

Through vendor contracts, New York State provided care management services to both children and adults. The vendors served patients with a call center, nurse care management, and disease education. Although the State had planned to end all demonstration programs in March 2008, New York extended its contract with two of the six vendors for an additional year because of their programs' successful impact on members.

For more information on the Learning Network, go to: http://www.ahrq.gov/qual/medicaidmgmt/.

Impact Case Study Identifier: KT-OCKT-26
AHRQ Product(s): Medicaid Medical Directors Learning Network
Topic(s): Chronic Care: Self-Management, Policy
Geographic Location: New York

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Page last reviewed March 2012
Internet Citation: New York Uses AHRQ Tools to Evaluate Pilot Medicaid Program. March 2012. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/policymakers/case-studies/ktockt26.html