Kaiser Family Foundation Survey on State Medicaid Managed Care ...

public health efforts to reduce disparities, with Medicaid participating in interagency and communitytask forces and statewide collaboratives.Wisconsin has implemented several efforts to reduce racial/ethnic disparities in poor birth outcomes. Oneincludes a medical home pilot project in the southeast region of the state, and a financial penalty for healthplans that fail to provide appropriate care for pregnant women who then have a poor birth outcome.Washington examines immunization data for racial/ethnic disparities. Having identified disparities in theRussian-speaking population, the state plans focus groups in 2011 to better understand the root causes ofunder-immunization of Russian-speaking children.States reported a broad spectrum of other, special managed care quality initiatives. A total of 26states reported managed care quality initiatives in a host of additional areas, reflecting diverse prioritiesand strategies. Among others, they mentioned quality initiatives focused on: perinatal care anddepression screening; improved care management for individuals with both behavioral health diagnosesand chronic conditions; identification of high-risk enrollees for intensive case management; dentalutilization; and improving the data available to providers to benchmark their performance. Many of theinitiatives involve strategic use of HEDIS© and CAHPS© data by states and plans, to measure andmonitor quality and drive improvement, sometimes via P4P approaches. In some states, the activity inMedicaid is part of a broader, statewide quality initiative.Arizona AHCCCS has formed work groups with contracted health plans and community stakeholders to addressissues such as low rates of breast and cervical cancer screening, childhood immunizations and well-child visits,and the need for better care management of members with behavioral health diagnoses who also have chronicconditions or development of toolkits for management by PCPs of some behavioral conditions such as anxiety,depression and ADHD. The work groups allow contractors, in conjunction with public agencies and othercommunity providers, to identify barriers, collaborate on interventions and share promising practices.Initiatives to improve primary care and care coordinationA large majority of Medicaid programs have a medical home initiative in place or under development.State Medicaid programs have long used the term “medical home” to capture the concept of firmlyconnecting the Medicaid enrollee with a particular primary care provider who has agreed to guaranteetimely access when care is needed. In recent years, the term has also taken on a more specific andcomprehensive meaning, associated with NCQA’s “Physician Practice Connections® - Patient CenteredMedical Home” program, which recognizes providers who meet a set of specified benchmarks asmedical home providers. 20Interest in medical homes spans public and private health insurers and payers, including Medicaid. In all,39 states reported having a medical home initiative in place (27 states) or under development (12states).A large majority of states have disease and/or care management programs, which are oftenintegrated into their managed care programs. Recognizing that a very small share of Medicaidbeneficiaries with very high needs and costs account for a large share of Medicaid spending, states haveincreasingly turned to disease management (DM) and care management (CM) programs to improve carefor people with specific chronic conditions. Early programs tended to focus narrowly on management of20 NCQA. See: http://www.ncqa.org/tabid/631/Default.aspx41