New Hampshire Guides New Program for High-Risk Medicaid Patients With AHRQ Tools

Prevention and Care Management
December 2009

The State of New Hampshire has developed a robust evaluation strategy and refined its health risk assessment 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. New Hampshire 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.

Doris Lotz, MD, MPH, New Hampshire's Medicaid Medical Director, discussed her experience with the AHRQ Learning Network, noting "It's so important—particularly for smaller States—to have access to the expertise and high quality work at AHRQ. Through the Medicaid Care Management Learning Network, our State was made aware of AHRQ tools and was able to engage experts to assist us with our specific problems and solutions. We were also able to learn from and share our successes and failures with the other Medicaid programs participating in the Network. The Learning Network was a very positive experience overall."

As a result of a legislative mandate in 2007, staff of the New Hampshire Department of Health and Human Services implemented an Enhanced Care Coordination (ECC) Program, to target high-risk members identified through predictive modeling. Program interventions include telephonic care management, health coaching, and patient education.

AHRQ worked closely with New Hampshire staff during the implementation of its ECC Program. Based on the principles outlined in AHRQ's publication, Monitoring and Evaluating Medicaid Fee-For-Service Care Management Programs: A User's Guide, AHRQ provided guidance and recommendations for the State's evaluation strategy. Specifically building on an example from the State of Washington's program, the agency outlined a framework for using a control group to evaluate the success of New Hampshire's program. As a result of technical assistance from the AHRQ-supported Learning Network, New Hampshire officials developed a robust evaluation approach using a control group to assist in the evaluation of the ECC Program.

Additionally, AHRQ assisted New Hampshire officials in refining its health risk assessment, a tool essential to the identification and enrollment process of New Hampshire's ECC program. New Hampshire staff needed and expected a high response rate; however, upon implementing its ECC program, they experienced a low response rate for its health risk assessment.

To help increase the response rate, AHRQ provided recommendations to improve the readability and health literacy level of the health risk assessment. AHRQ staff identified ways to reduce both medical jargon and the number of assessment questions. Specific tools shared with New Hampshire staff included AHRQ's evidence report, Literacy and Health Outcomes, and AHRQ's Web site, Testing Your Materials and Dissemination Strategy.

Influenced by the AHRQ Learning Network and other sources, New Hampshire staff implemented a shorter, more streamlined health risk assessment that ultimately achieved a 100 percent response rate.

Impact Case Study Identifier: 
AHRQ Product(s): Medicaid Medical Directors Learning Network
Topics(s): Chronic Care: Self-Management, Policy
Geographic Location: New Hampshire
Implementer: State of New Hampshire
Date: 12/01/2009
Page last reviewed October 2014