Moving Alabama Medicaid from a fee-for-service system that is based on visits and volume to one that focuses on value, quality and outcomes will require new ways of evaluating healthcare services offered by Regional Care Organizations, according to Dr. Robert Moon, Medicaid Medical Director and Deputy Commissioner, Health Systems.

To facilitate that change, a Quality Assurance Committee comprised of 23 physicians, pharmacists and other healthcare professionals has been meeting since October 2013 to determine the metrics by which the new RCO organizations will be measured. The QA committee was created under a 2013 law establishing Regional Care Organizations and is comprised of healthcare professionals of which 60 percent or more must be physicians. Click here to see a list of committee members. 

On April 17, the committee voted on a set of nationally recognized metrics. The committee recommended that five to 10 of these metrics be used in an incentive program for the RCOs, but that the other metrics in the set be used for monitoring RCO performance.  At the committee meeting in May other metrics will be considered for monitoring. 

“The amount of engagement and dedication to the work of the Committee by its members has been impressive,” Dr. Moon said. “While we were unsure of the participation we would receive when the process began, we have averaged over 90 percent attendance at all of the meetings, and have seen members put in considerable work and study between meetings.”

The QA Committee will meet again in May and June to finalize and adopt the initial set of measures for RCOs. The Agency will provide initial baseline analysis and technical assistance to the RCOs as they begin to develop their data collection and reporting systems. The goal is to have all measures in place when RCOs begin October 1, 2016.