Texas Uses AHRQ Tools to Design Medicaid Self-Management Program
The Texas Health and Human Services Commission developed initiatives to improve patient involvement and refined its provider communication strategy as a result of participating in the Medicaid Care Management Learning Network, an AHRQ Knowledge Transfer project. The Learning Network serves State Medicaid agencies that operate care management programs for chronically ill beneficiaries in fee-for-service or primary care case management. Texas is one of 17 States participating in the 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.
Patient involvement is critical in changing patient behavior. As a result of AHRQ workshop presentations and Web conferences, the Texas team learned of strategies used by other States to improve patient involvement, such as the Chronic Disease Self-Management Program developed by AHRQ-funded researcher Kate Lorig, RN, DrPH, a Professor in the Department of Medicine at Stanford University. The team also learned about the AHRQ-funded patient activation measure and AHRQ's publication "Patient Self-Management Support Programs: An Evaluation," which helped Texas officials design their patient self-management program.
The AHRQ workshops helped Texas officials strengthen relationships with the provider community, which provides input on the disease management program. Specifically, AHRQ provided the following recommendations to engage the Provider Advisory Board:
- Appointing physician "champions" to the Provider Advisory Board; these physicians are actively involved in the care management program and are influential among their peers.
- Meeting with State medical societies.
- Encouraging providers to present successful program elements to the Provider Advisory Board.
As a result of technical assistance provided by the Agency, Texas officials implemented new pilots and initiatives to their current program, including the following:
- Health and wellness initiative.
- Patient incentive initiative to engage and retain members in the program.
- Provider incentive pilot to provide updated patient demographics for hard-to-reach Medicaid clients.
- Diabetes home-monitoring pilot to improve diabetic clinical metrics.
- Integrated health care addressing behavioral health conditions of chronic depression and schizophrenia.
The Learning Network helped Texas officials redesign their traditional disease management program into a health management program. In addition to encouraging client self-management, the new program better serves clients with comorbid conditions and encourages providers to practice evidence-based care.
Ashley Fox, Disease Management Program Specialist for the Texas Health and Human Services Commission, comments, "Through the Learning Network, our program has gained new perspectives on the issues we face. We have benefited from assistance not only from AHRQ staff, but from [disease management program] administrators across the country. With the help of AHRQ and other States, we have increased the effectiveness of our [disease management] program."
For more information on the Medicaid Care Management Learning Network, go to: http://www.ahrq.gov/qual/medicaidmgmt/.