Introduction

More than 90 million Americans have

chronic illnesses, and approximately 20

million children have at least one

chronic health condition. Medical care

costs associated with chronic illness are

substantial and account for more than

75 percent of the Nation’s $1.4 trillion

in annual health care costs.1 Improving

care quality and reducing its cost for

patients with chronic illness(es)

represent a challenge for all Medicaid

programs. An increasing number of

States are developing or implementing

care management programs in an

attempt to meet this challenge. 

Despite growing interest, many States

simply do not have the technical

capabilities or financial resources

available within their agencies to

design, implement, and monitor such

programs to the degree they would like.

Through this new knowledge transfer

initiative, the Agency for Healthcare

Research and Quality is collaborating

with States to improve the health of

people with chronic illness through

successful care management programs.

What is AHRQ doing?

AHRQ is establishing a learning

network to help State Medicaid

agencies measure and improve the

quality of care for Medicaid

beneficiaries with multiple chronic

diseases. 

With whom?

• Four to eight “action ready” State

Medicaid programs that have

recently implemented care

management or disease management

programs or are well along in

planning for such programs. 

• One or two States that will

participate with regional coalitions

that include at least health plans and

purchasers and focus on care

management at the provider level.

The mission of AHRQ is to improve the quality,

safety, efficiency, and effectiveness of health

care by:

• Using evidence to improve health care.

• Improving health care outcomes through

research.

• Transforming research into practice.

Quality Improvement and

Performance Measurement in

Medicaid Care Management

FACT SHEET

Advancing Excellence in Health Care • www.ahrq.gov

Agency for Healthcare Research and Quality

Agency for Healthcare Research and Quality

1 Source: Centers for Disease Control and

Prevention, October 1994.
2

• AHRQ's Federal partners are the

Centers for Medicare & Medicaid

Services (Medicaid Quality Strategy)

and the Centers for Disease Control

and Prevention. 

• Non-Federal partners are the

National Committee for Quality

Assurance, the National Academy

for State Health Policy (NASHP),

and the Center for Health Care

Strategies.

Why?

• Medicaid beneficiaries who lack

effective care management often

receive lower quality care for

chronic disease. Also, State

Medicaid programs may experience

over-use of hospital and other

services and increasing costs.

• Very few State Medicaid agencies

have implemented care

management programs for chronic

conditions.

• States are inexperienced in

developing performance

measurement systems or designing

quality improvement (QI) projects,

and they have scant resources inhouse to develop these programs.

• Without performance

measurement, it is difficult to

implement QI strategies.

• AHRQ has the information, tools,

expertise, and linkages with the

research community to help States

develop effective strategies for their

care management programs.

How are AHRQ resources being

used?

• Create and support a multi-State

learning network.

• Make site visits to States to identify

and prioritize their needs. 

• Provide technical assistance and

facilitate peer to peer learning.

• Identify ways AHRQ (and others)

can help States decide what to focus

on, which strategies work, and what

and how to measure. 

• Promote sharing of strategies among

States, identify best practices, and

use evidence-based research

(workshops, teleconferences, Web

site/extranet, peer-to-peer assistance,

particularly with peers who have

had success with concrete

solutions). 

How will we know success?

• States will be able to use tools and

knowledge gained through the

network to measure outcomes by

collecting, analyzing, and

documenting changes in care.

• Quality of care will improve for

Medicaid beneficiaries with multiple

chronic diseases.

• States will present results/lessons

learned through the AHRQ

learning network at yearly national

meetings of State-based

organizations such as NASHP.

• Additional States outside of the

learning network will approach

AHRQ for help in developing their

expertise, tools, and measures. 

Synergies with other AHRQ programs

The AHRQ Care Management

Strategy Workgroup will work closely

with AHRQ staff in the following

programs to ensure that the most

appropriate tools are used in the

learning network:

• National Healthcare Quality Report

and National Healthcare Disparities

Report.

• Quality Connect, a partnership

with State and local leaders to

improve the quality of health care

and help States achieve greater value

for their health care investments.

• AHRQ Quality Indicators.

• Healthcare Cost and Utilization

Project.

• Knowledge transfer strategies for

decreasing disparities in pediatric

asthma care.

• Purchaser-provider synergies

knowledge transfer strategy.

• Diabetes workbook for States

(Center for Quality Improvement

and Patient Safety).

• Supporting business coalitions on

diabetes QI (Center for Quality

Improvement and Patient Safety).

• Long-term care portfolio.

• Center for Financing, Access, and

Cost Trends and Center for

Outcomes and Effectiveness for

activities relating to costs of chronic

illness.

When will we reassess?

We will reassess continuously to ensure

that specific projects are on track. We

will perform an in-depth assessment at

least every 6 months to gauge whether

a change in overall strategy is needed. 

www.ahrq.gov

AHRQ Pub No. 05-P024-1

August 2005