This page contains links to tools, protocols, and useful information for planners and managers of Medicaid quality processes.

• The EQR Managed Care Organization Protocol describes the process for review of EQRO performance.
• The CHCS ROI Calculator offers a simple, intuitive process for determining the probable payoff for quality initiatives in Medicaid and CHIP.
• The NCQA Medicaid Managed Care Toolkit 2008 Health Plan Accreditation Standards provides NCQA guidance regarding how State Medicaid agencies can use information obtained from NCQA accreditation surveys to help meet requirements of Federal regulations at 42 CFR 438 Subpart E while avoiding duplication of effort. While not an official CMS document, this toolkit has been reviewed by CMS staff, and States may find it a useful resource.

AHRQ Tools for Disease Management

In May 2008, the Agency for Healthcare Research and Quality (AHRQ) released a package of tools to help decision-makers responsible for operating Medicaid fee-for-service or primary care case management programs to plan, develop, implement and evaluate their disease or care management programs.  These documents are "Designing and Implementing Medicaid Disease and Care Management Programs: A User's Guide" (AHRQ Publication No. 07(08)-0063), "Monitoring and Evaluating Medicaid Fee-for-Service Care Management Programs: A User's Guide" (AHRQ Publication No. 08-0012), and "Patient Self-Management Support Programs: An Evaluation" (AHRQ Publication No. 08-0011). In addition, AHRQ funded the research that formed the basis for an article entitled, "Management Tools for Medicaid and State Children's Health Insurance Program (CHIP)", which is intended to support State efforts to make more effective use of administrative data for quality-related purposes. These publications are available via the links and download below:

CDC Chronic Disease Cost Calculator

The Centers for Disease Control and Prevention (CDC) has made available to States the Chronic Disease Calculator, a downloadable tool capable of generating Medicaid estimates for six chronic diseases, including stroke, heart failure, heart disease, hypertension, diabetes, and cancer. This tool can be used by States to make informed decisions about fiscal issues and new prevention and intervention options for such conditions. The Calculator was developed with input from various organizations, including the Agency for Healthcare Research and Quality and the National Pharmacy Council, as well as disease specialists, epidemiologists, and economists. For each State, the calculator estimates the disease prevalence, costs per person, and total costs of the disease(s). The Calculator can also estimate results for a particular disease by age group, gender, or Medicaid populations. Future iterations of the disease calculator will address other conditions (e.g., asthma, depression, and arthritis), other payers (e.g., Medicare and private payers), and indirect costs (i.e., lost productivity). To obtain copies of a Chronic Disease Calculator PowerPoint and poster presentations, User Guide, Technical Appendix, and Frequently Asked Questions contact Diane Orenstein, CDC, at Diane.Orenstein@cdc.hhs.gov or CMS at medicaidquality@cms.hhs.gov. CDC also welcomes feedback on how States have used this tool and the extent to which they have found it helpful.

Downloads
EQR Managed Care Organization Protocol [ZIP, 206 KB] Center for Health Care Strategies' Quality Initiative ROI Calculator [PDF, 1.4 MB] External Quality Review Kit for State Medicaid Agencies [PDF, 49 KB] State Quality Strategy Toolkit for State Medicaid Agencies [PDF, 244 KB] Management Tools for Medicaid and State Children's Health Insurance Program (CHIP) [PDF, 114 KB] MITA and Quality Abstract [PDF, 86 KB]
Related Links Inside CMS
There are no Related Links Inside CMS
Related Links Outside CMS
Leapfrog Group Guide for State Medicaid Agencies [PDF, 674 KB] NCQA Medicaid Managed Care Toolkit (2008) [PDF, 104 KB] Designing and Implementing Medicaid Disease and Care Management Programs: A Users' Guide [PDF. 94 KB] Monitoring and Evaluating Medicaid Fee-for-Service Care Management Programs: A User's Guide [PDF, 610 KB] Patient Self-Management Support Programs: An Evaluation [PDF, 373 KB]

Page Last Modified: 04/02/2009 6:34:57 AM
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