Designing and Implementing Medicaid Disease and Care Management Programs

A User's Guide

More than half of the Nation's States have implemented Medicaid care management programs to improve the quality of care for people with chronic conditions. Since 2005, 18 States have reviewed and analyzed the experiences of other States, best practices, and evaluation methodologies to identify the best solutions for their State. This Medicaid Care Management Guide reflects the experiences of the initial 13 Learning Network States.

Prepared for the Agency for Healthcare Research and Quality (AHRQ) by the Lewin Group under Contract No. 290-04-0011. 


By Roshni Arora, Jessica Boehm, Lisa Chimento, Lauren Moldawer, Catherine Tsien.
Contributors: David Atkins, Cindy Brach, Kathy Moses, Joanie Rothstein, Margie Shofer, David Stevens

Contents

Disclaimer
Acknowledgements
Copyright
Introduction
Section 1: Planning a Care Management Program
Section 2: Engaging Stakeholders in a Care Management Program
Section 3: Selecting and Targeting Populations for a Care Management Program
Section 4: Selecting Care Management Interventions
Section 5: Selecting a Care Management Program Model
Section 6: Operating a Care Management Program
Section 7: Measuring Value in a Care Management Program
Section 8: The Care Management Evidence Base
   Review Synopsis: Diabetes
   Review Synopsis: Asthma
   Review Synopsis: Congestive Heart Failure
   Review Synopsis: Chronic Obstructive Pulmonary Disease 
   Review Synopsis: Coronary Artery Disease
Appendix: State Overviews

 

Disclaimer

This User's Guide was prepared by The Lewin Group under contract to the Agency for Healthcare Research and Quality (AHRQ), Rockville, MD (Contract No. 290-04-0011). The findings and conclusions in this document are those of the authors, who are responsible for its content, and do not necessarily represent the views of AHRQ. No statement in this report should be construed as an official position of AHRQ or of the U.S. Department of Health and Human Services. 

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Acknowledgements

This Guide could not have been produced without the assistance of a number of people. AHRQ and The Lewin Group would especially like to acknowledge the AHRQ Medicaid Care Management Learning Network States for their contributions to the Guide. Through participation in the AHRQ Medicaid Care Management Learning Network, the 13 participating States provided much of the Guide's content. In addition, many of the States' participants and other individuals provided feedback and content. In particular, we would like to acknowledge the time and effort of the following individuals:

Ron Ackerman, M.D., M.P.H., Assistant Professor of Medicine, Affiliated Scientist of the Regenstrief Institute, Indiana University School of Medicine.
Melanie Bella, M.B.A., Senior Vice President, Center for Health Care Strategies.
Ashley Fox, Disease Management Program Specialist, Texas Health and Human Services Commission.
Denise Levis Hewson, R.N., B.S.N., M.S.P.H, Director of Quality Improvement and Clinical Operations, Community Care of North Carolina.
Alice Lind, B.S.N., M.P.H., Office Chief, Quality and Care Management, Washington Department of Social and Health Services.
Mary Miller, Program Manager/Disease Management, Illinois Department of Healthcare and Family Services.
Rebecca Pasternik-Ikard, Director, SoonerCare Program Operations & Benefits, Oklahoma Health Care Authority.
Cheryl Roberts, Deputy Director, Programs and Operations, Virginia Department of Medical Assistance Services. 

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Copyright Information

This document is in the public domain and may be used and reprinted without permission except those copyrighted materials noted for which further reproduction is prohibited without the specific permission of copyright holders.

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Current as of March 2008
Internet Citation: Designing and Implementing Medicaid Disease and Care Management Programs: A User's Guide. March 2008. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/professionals/systems/long-term-care/resources/hcbs/medicaidmgmt/index.html