Arizona Uses AHRQ Tools to Pilot Medicaid Program for Native Americans

As a result of participating in the Medicaid Care Management Learning Network, an AHRQ Knowledge Transfer project, the State of Arizona has developed a plan to implement a care management demonstration project for its Medicaid members within the Indian Health Service (IHS). The State has also improved the health literacy level of its first member handbook for its fee-for-service Native American members.

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. Arizona 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.

The IHS provides care to Native Americans living in Arizona, including those with Medicaid. While the IHS has several initiatives targeting patients with chronic conditions, it has little coordination with Arizona's Medicaid Agency, the Arizona Health Care Cost Containment System (AHCCCS). When Arizona joined the Learning Network, the State was interested in improving the quality of and access to care for the Native American population.

Participation in the Learning Network provided AHCCCS and the IHS an improved forum to collaborate and work together. This led AHCCCS to develop and pursue a new care management demonstration project in collaboration with the IHS. Without the AHRQ-sponsored Learning Network, Arizona would not have pursued this—or any—care management project.

The AHRQ project team used information from AHRQ's publication, Designing and Implementing Medicaid Care Management Programs: A User's Guide, along with examples from other States, to provide recommendations on several program components. These included selecting targeted populations, reviewing options for payment, and care management interventions.

John Molina, AHCCCS Medical Director and Assistant Director for Arizona's Division of Fee-for-Service Management, notes, "Unlike our contracted health plans, our fee-for-service program that covers our Native American members does not have administrative dollars for care management and similar activities. Thanks to our two-year relationship with AHRQ, we are actively pursuing a demonstration project that would provide care management services at two IHS facilities in Arizona. The insight we gained as part of the AHRQ Care Management Learning Network has been extremely valuable."

The AHRQ project team also reviewed and provided feedback to the State on its new member handbook for the Native American population. Building on several AHRQ health literacy tools, the project team provided specific guidance on reducing the use of medical jargon and field testing the handbook prior to completion. As a result of the Learning Network's guidance, Arizona developed a member handbook that is at an appropriate health literacy level for the population it serves.