Cross-State Collaboration and Research Opportunities
Immunization Barriers in the United States: Targeting Medicaid Partnerships through Community of Practice
With funding from the CDC, AcademyHealth collaborates with the National Academy for State Health Policy (NASHP) and the Colorado Children’s Immunization Coalition (CCIC) in a three year project, to enhance collaborative immunization efforts across Medicaid, public health agencies and Immunization Information Systems (IIS) divisions to improve immunization rates for children and pregnant women with Medicaid coverage. Through the formation of a Community of Practice (CoP) and engagement with select MMDs, this project provides technical assistance to five states, Colorado, Hawaii, Kentucky, Montana, and New Mexico. Each state’s multidisciplinary team includes Medicaid, public health, and Immunization Information System (IIS) representation, and targets specific immunization goals to achieve during the course of the project.
Opioid Use Disorder Project
State Medicaid programs play a critical role in financing pharmacologic and non-pharmacologic treatments for opioid use disorder (OUD) as they provide coverage for 4 in 10 individuals with OUD. States are currently taking myriad approaches to addressing the opioid crisis by changing the way they regulate providers, pay for care, and cover evidence-based treatments in Medicaid. However, there exists no analytic infrastructure for learning about the impact of state policy experimentation on OUD treatment and outcomes as states have no mechanism for sharing data or measurement tools. To overcome these challenges, we harness MODRN state-university partnerships in Delaware, Kentucky, Maryland, Michigan, North Carolina, Ohio, Pennsylvania, Tennessee, Virginia, West Virginia, and Wisconsin along with MMDN collaboration. Our objectives continue to provide a comprehensive assessment of OUD treatment quality and outcomes in Medicaid, and to inform policy decisions on coverage and payment for evidence-based OUD treatments in Medicaid.
Adult and Child Core Measure Prioritization
In its current efforts reviewing the Adult and Child Core Sets, CMCS has engaged with Medicaid quality stakeholders via the MMDN to identify gaps in the measure sets and prioritize measure topics for future development and implementation. The consensus development process was designed to generate discussion around the complexities of aligning measures across diverse state landscapes, particularly in reference to health care priorities, payment systems, data/reporting infrastructure, and implementation capacity. Specifically, the Medicaid clinical leaders were tasked with 1) identifying and prioritizing gap areas in the current Adult and Child Core Sets, based on their close working knowledge of the priorities in their states as well as their clinical expertise as physicians; 2) identifying and prioritizing specific measure topics that would address the gap areas; and 3) providing any insights into the development and testing of the prioritized measure topics, including providing examples of analogous measure development efforts occurring in their respective states.
Medicaid Strategies to Implement Comprehensive PrEP Intervention Services
AcademyHealth, ChangeLab Solutions (CLS), and the CDC collaborated to reduce the spread of sexually transmitted diseases among Medicaid beneficiaries, including HIV, and the subsequent consequences for their communities by improving the access to and coverage for recommended and appropriate HIV pre-exposure prophylaxis (PrEP) intervention services, such as STD screening and treatment. This project sought to improve Medicaid availability and delivery of the PrEP intervention package, particularly recommended clinical monitoring and follow-up services such as STD screening and treatment, by assessing and addressing structural, operational, financial, and knowledge barriers regarding PrEP intervention services among providers, payers, and public health leaders.
Past Collaborative Research Projects
Hospital Readmissions Project
Reducing hospital readmissions is a way to improve care and reduce avoidable costs. However, there have been few studies of readmissions in the Medicaid population. The MMDN sought to characterize acute care hospital admissions and thirty-day readmissions in the Medicaid population through a retrospective analysis in nineteen states. They found that Medicaid readmissions were both prevalent (9.4 percent of all admissions) and costly ($77 million per state) and that they represented 12.5 percent of Medicaid payments for all hospitalizations. Five diagnostic groups appeared to drive Medicaid readmissions, accounting for 57 percent of readmissions and 49 percent of hospital payments for readmissions. The most prevalent diagnostic categories were mental and behavioral disorders and diagnoses related to pregnancy, childbirth, and their complications, which together accounted for 31.2 percent of readmissions. This analysis, conducted through the Medicaid Medical Directors Learning Network, allows Medicaid medical directors to better understand the nature and prevalence of hospital use in the Medicaid population and provides a baseline for measuring improvement.
Early Elective Delivery Project
Reducing early elective deliveries has become a priority for Medicaid Medical Directors and their state partners. Such deliveries lead to poor health outcomes for newborns and their mothers and generate additional costs for patients, providers, and Medicaid, which pays for up to 48 percent of all births in the United States each year. Early elective deliveries are non–medically indicated labor inductions or cesarean deliveries of infants with a confirmed gestational age of less than thirty-nine weeks. This retrospective descriptive study reports the results of a perinatal project, led by the state Medicaid Medical Directors, which sought to coordinate quality improvement efforts related to early elective deliveries for the Medicaid population. Twenty-two states participated in the project and provided data on elective deliveries in the period 2010–2012. They found that 75,131 (8.9 percent) of 839,688 Medicaid singleton births were early elective deliveries. Thus, they estimated that there are 160,000 early elective Medicaid deliveries nationwide each year. In twelve states, early-term elective deliveries declined 32 percent between 2007 and 2011. This study offers additional evidence and new tools for policy makers pursuing strategies to further reduce the number of such deliveries.
Atypical Anti-Psychotics Use in Kids
Increased use of atypical antipsychotic medications for a broadened range of patients and indications, often off-label, has raised a range of policy challenges for payers, patients and clinicians. In response to these concerns, the challenges of mental health services in Medicaid were discussed among State Medicaid Medical Directors and investigators from the Rutgers CERT (Center for Education and Research on Mental Health Therapeutics) in June 2007 during an Agency for Healthcare Research and Quality (AHRQ) supported Medicaid Medical Directors Learning Network meeting. Out of that discussion, State Medicaid Medical Directors and the Rutgers CERT developed a plan for a collaborative project to examine the use of antipsychotic (AP) medications for children and adolescents in Medicaid. Shared measures and a data dictionary were developed and used as a guide by Sates to conduct analyses of their own data for this project. Vital convening, expertise, and other support for the project was provided through the AHRQ-funded Rutgers CERT and Medicaid Medical Directors Learning Network (MMDLN).