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Monitoring and Evaluating Medicaid Fee-for-Service Care Management Programs: User's Guide

Appendix 1. Example Measures for Evaluating the Impact of Medicaid Care Management

This table provides examples of different measures that could be used by States to monitor and evaluate their CM programs. This is not an exhaustive list of measures. We have divided the measures into six types: intervention-process, quality-process, quality-outcome, satisfaction, utilization, and cost.

Appendix Table. Examples of Evaluation Measures

TypeMeasureDescriptionData source
Intervention—processEligible for CMPercent of beneficiaries who are eligible for the CM program, among all beneficiariesAdministrative data (and/or health risk appraisals
Enrolled in CMPercent of beneficiaries who are enrolled in CM, among all eligibleAdministrative data
Engaged in CMPercent of beneficiaries who are engaged in the CM program, among all enrolledAdministrative data
Quality—processSmoking cessationPercent of enrollees who received advice to quit smoking among all smokers enrolled in CMMedical record
Blood pressurePercent of patients with BP measurement recorded among those enrolled in CMMedical record
LDL cholesterol screenPercent of patients who have documentation in the medical record of cholesterol screening within the last year among those enrolled in CMMedical record
Lipid profilePercent of patients receiving at least one LDL-C screen among those enrolled in CMAdministrative: lab claims
ACE inhibitorPercent of patients with CAD who have diabetes and were prescribed ACE inhibitorAdministrative: pharmacy claims
HbA1c screenPercent of patients with diabetes receiving HbA1c screen within the past yearMedical record
Retinal examPercent of patients with diabetes who have had a retinal exam in the past yearAdministrative: claims
Quality—outcomeBlood pressure managementPercent of patients with most recent BP <140/90 mmHg among those enrolled in CMMedical record
LDL cholesterol controlPercent of patients with diabetes with most recent LDL-C <130 mg/dLMedical record
SatisfactionCAHPS™Patient experience of careSurvey
UtilizationHospital admissionsNumber of hospital admissions in last year among those enrolled in CMAdministrative: claims
ED useNumber of emergency department visits in last year among those enrolled in CMAdministrative: claims
Physician visitsNumber of physician visits in last year among those enrolled in CMAdministrative: claims
PharmacyNumber of 30-day prescriptions filled in last year among those enrolled in CMAdministrative: pharmacy claims
CostHospital claimsTotal $ of hospital claims paidAdministrative: hospital claims
Pharmacy claimsTotal $ in pharmacy claims paidAdministrative: pharmacy claims
Total expendituresTotal $ in claims paidAdministrative: claims

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Current as of November 2007
Internet Citation: Monitoring and Evaluating Medicaid Fee-for-Service Care Management Programs: User's Guide. November 2007. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/research/findings/final-reports/medicaid-ffs/medicaidffsap1.html