Fact Sheet
Despite growing interest, many States do not have the technical capabilities
or financial resources available to design, implement, and monitor care management
programs. The Agency for Healthcare Research and Quality (AHRQ) is now collaborating
with States to improve the health of people with chronic illness through successful
care management programs.
Introduction / What Is AHRQ Doing? / With Whom? / Why? / How Are AHRQ Resources Being Used? / How Will We Know Success? / Synergies With AHRQ Programs / When Will We Reassess?
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Introduction
More than 90 million Americans have chronic illnesses, and approximately
20 million children have at least one chronic health condition. Medical
care costs
associated with chronic illness are substantial and account for more than 75
percent of the Nation’s $1.4 trillion in annual health care costs.1
Improving care quality and reducing its cost for patients with chronic illness(es)
represent a challenge for all Medicaid programs. An increasing number of States
are developing or implementing care management programs in an attempt to meet
this challenge.
Despite growing interest, many States simply do not have the technical capabilities
or financial resources available within their agencies to design, implement,
and monitor such programs to the degree they would like. Through this new knowledge
transfer initiative, the Agency for Healthcare Research and Quality is collaborating
with States to improve the health of people with chronic illness through successful
care management programs.
1. Source: Centers for Disease Control and Prevention, October 1994.
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What Is AHRQ Doing?
AHRQ is establishing a learning network to help State Medicaid agencies measure
and improve the quality of care for Medicaid beneficiaries with multiple chronic
diseases.
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With Whom?
- Four to eight "action ready" State Medicaid programs that have
recently implemented care management or disease management programs or are
well along in planning for such programs.
- One or two States that will participate with regional coalitions that include
at least health plans and purchasers and focus on care management at the provider
level.
- AHRQ’s Federal partners are the Centers for Medicare & Medicaid Services
(Medicaid Quality Strategy) and the Centers for Disease Control and Prevention.
- Non-Federal partners are the National Committee for Quality Assurance, the National
Academy for State Health Policy (NASHP), and the Center for Health Care Strategies.
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Why?
- Medicaid beneficiaries who lack effective care management often receive lower
qualify care for chronic disease. Also, State Medicaid programs may experience
over-use of hospital and other services and increasing costs.
- Very few State Medicaid agencies have implemented care management programs for
chronic conditions.
- States are inexperienced in developing performance measurement systems or designing
qualify improvement (QI) projects, and they have scant resources in-house to
develop these programs.
- Without performance measurement,it is difficult to implement QI strategies.
- AHRQ has the information, tools, expertise, and linkages with the research community
to help States develop effective strategies for their care management programs.
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How Will AHRQ's Resources Be Used?
- Create and support a multi-State learning network.
- Make site visits to States to identify and prioritize their needs.
- Provide technical assistance and facilitate peer to peer learning.
- Identify ways AHRQ (and others) can help States decide what to focus on, which
strategies work, and what and how to measure.
- Promote sharing of strategies among States, identifying best practices,
and use evidence-based research (workshops, teleconferences, Web site/extranet,
peer-to-peer
assistance, particularly with peers who have had success with concrete solutions).
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How Will We Know Success?
- States will be able to use tools and knowledge gained through the network to
measure outcomes by collecting, analyzing, and documenting changes in care.
- Quality of care will improved for Medicaid beneficiaries with multiple
chronic diseases.
- States will present results/lessons learned through the AHRQ learning network
at yearly national meetings of State-based organizations such as NASHP.
- Additional States outside of the learning network will approach AHRQ for help
in developing their expertise, tools, and measures.
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Synergies with Other AHRQ Programs
The AHRQ Care Management Strategy Workgroup will work closely with AHRQ staff
in the following programs to ensure that the most appropriate tools are used
in the learning network:
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When Will We Reassess?
We will reassess continuously to ensure that specific projects are on track.
We will perform an in-depth assessment at least every 6 months to gauge
whether
a change in overall strategy is needed.
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AHRQ Publication No. 05-P024-1
Current as of August 2005
Internet Citation:
Quality Improvement and Performance Measurement in Medicaid Care Management. Fact Sheet. AHRQ Publication No. 05-P024-1, August 2005. Agency for Healthcare Research
and Quality, Rockville, MD. http://www.ahrq.gov/qual/qimedicaid.htm
540 Gaither Road Rockville, MD 20850