Prevention/Care Management, 2009

State of Washington

May 2009

The State of Washington changed its Medicaid programs as a result of an AHRQ-supported Learning Network for State Medicaid programs. The Learning Network has had significant impact on Washington State in the areas of program planning and implementation and evaluation design.

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 D.
• Designing valid and reliable evaluations to determine program success.

The Washington Medicaid program is one of 17 States participating in this Learning Network. 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.

During its two-year participation in the Learning Network, Washington piloted an improved care management program. Through workshop presentations, web conferences, and individual technical assistance, AHRQ assisted the State in designing and implementing a new program by providing assistance on program design, a request for proposal development, pilot testing programs, and prioritizing patients.

Washington's new care management program began in January 2007, replacing a previous disease management program. The new program focuses on the comprehensive treatment of members. It serves the top 20 percent of high-risk Medicaid clients. Washington works with both a Statewide vendor and local vendor to provide care management to these selected clients through in-person care management, telephonic care management, educational materials, and the medical home.

Alice Lind, former Washington Office Chief, Quality and Care Management, Department of Social and Health Services, reports that participating in the Learning Network helped the State to "clarify, validate, and guide [us] in developing the vision."

As part of the Learning Network, AHRQ solicited the assistance of States with "advanced" care management programs to act as faculty members. One of these States—North Carolina—particularly impacted Washington's program design. Using North Carolina's program as a model, the State of Washington implemented a program with a strong focus on the medical home and a partnership with a local vendor. The medical home is an approach to delivering primary health care through a team partnership that ensures health care services are provided in a high quality comprehensive manner, including acute, chronic, and preventive care.

By emphasizing the importance of a medical home for members and partnering with a local vendor to provide care management services, Washington developed a program that accesses local resources and more effectively involves primary care providers. The Statewide vendor also supports the local vendor through a predictive modeling software application that helps the local vendor predict an individual's future need for care.

In addition to program planning and implementation improvements, Washington State has applied two key evaluation lessons provided by Learning Network technical assistance:

• Plan the program evaluation early.
• Use a control group for the most rigorous evaluation methodology.

As Washington State planned its program, it also began planning its evaluation and solicited AHRQ's assistance. AHRQ staff provided input on the evaluation design, including methods for creating a control group. By designing its evaluation early, the State was able to successfully create a control group by stratifying three groups of members into control and test groups. The test groups received care management services, while the control groups received services after one year.

For more information on the Learning Networks, go to: http://www.ahrq.gov/qual/qimedicaid.htm.

Impact Case Study Identifier: KT-OCKT 07
AHRQ Product: Medicaid Care Management Learning Network
Topic(s): Policy
Scope: Washington

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