Washington State Medicaid Uses AHRQ Research to Improve Clinical Policy
As part of its participation in the Medicaid Medical Directors' Learning Network—an AHRQ Knowledge Transfer project—Washington State Medicaid used AHRQ technology assessments, systematic reviews, and comparative effectiveness reviews from the Effective Health Care (EHC) program to refine clinical policy. The State also used data from the Healthcare Cost and Utilization Project (HCUP) to develop tracking measures for facilities.
Jeff Thompson, MD, Chief Medical Officer of Washington State Medicaid, says, "AHRQ's resources have been instrumental in helping Washington State develop policies that improve the quality of health care for Medicaid recipients."
Ways in which the AHRQ resources have been influential in policy changes in the State include the following:
Vaginal Birth After Cesarean (VBAC): New Insights, Evidence Report/Technology Assessment No. 191, helped the State design and facilitate two new programs: a provider feedback report on cesarean delivery, preterm delivery, and VBAC rates; and a statewide hospital quality incentive program for reducing preterm deliveries and low-risk cesarean births in hospitals. These efforts led to substantial cost savings for the State.
Cesarean Delivery on Maternal Request, Evidence Report/Technology Assessment No. 133, helped enact legislation allowing for development of patient decision aids to help educate patients, physicians, hospitals, and birth centers about the risks and benefits of cesarean delivery.
Negative Pressure Wound Therapy Devices, an AHRQ Technology Assessment, found that there were no studies comparing generic wound vacuum-assist devices and brand-name devices and therefore no conclusions could be made about whether there is a clinical distinction between one system compared to another. The report's list of generic vendors is shared with long-term care and skilled nursing facilities, and the increased use of generic devices has helped decrease costs.
Comparative Effectiveness of Management Strategies for Gastroesophageal Reflux Disease, Comparative Effectiveness Review No. 1, was influential in initiating a proton pump inhibitor (PPI)/H2 blocker clinical decisionmaking algorithm. The Washington State Medicaid clinical algorithm policy now requires prescribers to demonstrate medical necessity for extended use of PPIs beyond 8 weeks. This program resulted in substantial savings and is an early trendsetter in reducing PPI overuse.
Effectiveness of Noninvasive Diagnostic Tests for Breast Abnormalities, Comparative Effectiveness Review No. 2, was used by Washington's State Health Technology Assessment Program to influence a policy change that required evidence of conventional imaging prior to authorizing a positron emission tomography scan for breast cancer.
Comparative Effectiveness of Percutaneous Coronary Interventions and Coronary Artery Bypass Grafting for Coronary Artery Disease, Comparative Effectiveness Review No. 9, helped assist the State in setting limits for drug-eluding stents.
Additionally, the Washington State Medicaid used data from HCUP to develop data reports and measures for its new Medicaid Management Information System. Developed in May 2010, this system includes a data warehouse to track spending as well as facility trends and professional services. Thompson reports that the system has "made it easier to track use within Medicaid."
AHRQ's evidence reports are available at http://www.ahrq.gov/clinic/epcindex.htm. Technology assessments are available at http://www.ahrq.gov/clinic/techix.htm, and EHC reports and guides are available at http://www.effectivehealthcare.ahrq.gov. More information about HCUP is available at http://www.hcup-us.ahrq.gov/home.jsp.