Each year, the Alabama Medicaid Agency measures the accuracy and timeliness of claims payments and checks to make sure recipients are properly qualified to receive services. However, it is difficult to measure if improved patient care results in savings for the agency.

Now, Alabama Medicaid’s participation in a national quality improvement project is providing a new tool for the Agency to more precisely evaluate the value of care provided to recipients with chronic illnesses like asthma and diabetes, according to Dr. Mary G. McIntyre, Medical Director of the Agency’s Office of Clinical Standards and Quality.

The new tool, called the Return on Investment (ROI) calculator, came to Dr. McIntyre’s attention during an Agency for Healthcare Research and Quality (AHRQ) conference in 2008. A federal agency, AHRQ supports research designed to improve the quality, safety, efficiency, and effectiveness of health care for all Americans. Developed by AHRQ, the new technology offered a means to objectively assess the effectiveness of a care management program for chronically ill patients.

Alabama selected the Asthma ROI calculator to determine if the Agency’s Q⁴U care management program is meeting quality goals. The ROI will determine if this component of the Together For Quality initiative is improving care for these individuals while saving money for the Agency.
 

During the past year, Dr. McIntyre and Stephanie Lindsay of the Agency’s Statistical Support Unit worked closely with the AHRQ’s tool developers to determine how to capture, input and save data for the calculator so the data and results could be reviewed later for accuracy. When software compatibility problems arose, Medicaid agreed to serve as beta testers for the on-line version of the ROI tool. Data will be collected through March 2010 to determine if improvements and cost savings occur.

“The fact that the calculator will allow someone other than Agency staff to defend the validity of the program was a key benefit. Also, having their technical assistance was another benefit to our staff,” she said.

Using the ROI calculator for the asthma care management provides another level of assessment to the external evaluation to be performed by the University of Alabama at Birmingham’s School of Public Health, Dr. McIntyre said. “These results will help Medicaid undertake meaningful quality improvement efforts that will allow Medicaid and its health care providers to increase efficiency, decrease costs and make measurable improvements in the quality of care offered to Medicaid recipients.”