Together For Quality

1. Together For Quality Alabama Medicaid Agency

2. Pilot Project Counties

3. Component of Together for Quality that provides for comprehensive chronic care management program • Asthma and Diabetes are Targeted Diseases • Protocols Designed to Affect all Disease Facets • Accomplished through Alabama Dept. of Public Health Care Coordinators (aka Care Managers) • Care Managers Provide Patient Training, Education, and Reinforcement What is Q4U?

4. Diabetes • Influenza Immunization • Annual HbA1C • Annual Lipid Profile • Annual Eye Exam • Annual Urine Protein Screening • Asthma • Asthma Controller Use • Influenza Immunization • Emergency Department Visits • Hospitalizations Measures • Developed by the Clinical Workgroup • Target Goals

5. From RMEDE • Patient 1st Recipients • Five, four, etc. Missed Opportunities • Stratified by High, Medium and Low • Patient 1st PMP Agrees to Participate • Strive to Enroll 120% of Target • Minimum Six Months Enrollment Q4U Patients

6. Significant Number of Patients with Missed Opportunities • Face-to-Face • Provider Notebook • Provider Agreement • List of Patients Referred to Care Management • Ongoing Reporting Through RMEDE Q4U PMP Recruitment

7. Online Referral System through State ADPH • Demographics are Provided to County Level Care Managers • Patient Contact • Enrollment Accomplished Through Home Visit • Patient has Ability to Refuse Patient Enrollment

8. Schedule of Monthly Follow-Up • Ongoing Contact with PMP/Nurse • ADPH Monthly Survey • RMEDE Reporting • Appropriate Coordination with Other Caregivers and Schools • Disease Specific Educational Material • Works With Entire Family Once Enrolled

9. Bullock County Resident • Four Missed Opportunities • Not Very Compliant • Enrolled in the Program • Initial Home Visit • Subsequent Visits/Contacts • Coordination with PMP • Ongoing Intervention Patient Example

10. Q4U Implementation Pilot Providers Patients Enrolled To Date Bullock Asthma – 25 Diabetes – 0 Pike Asthma – 59 Diabetes – 9 • February/March • Bullock – 3 sites, 4 providers • Pike – 7 sites, 18 providers • April • Montgomery – 11 sites, 23 providers • Calhoun – 16 sites, 31 providers • Talladega – 5 sites, 14 providers • May – recruitment underway

11. Together for QualityClinical Workgroup Update April 9, 2008 Mary G. McIntyre, M.D., M.P.H

12. TFQ Quality Improvement Performance Measures County Specific

13. Review of NCQA “The Plan” • Provider driven versus consumer driven • Establishment of 12 month change • Asthma 0.5 to 1.0 percentage point reduction from baseline for all but Annual Influenza Immunization (Lower is Best) • Diabetes – 5 percentage point increase from the baseline (Higher is Best) Targets Chosen

14. Overall Pilot County Percentages

15. Diabetes (Overall Pilot Co. Percentages)

16. Asthma (Overall Pilot Co. Percentages)

17. Individual County Results

18. BULLOCK

19. CALHOUN

20. HOUSTON

21. JEFFERSON

22. LAMAR

23. MONTGOMERY

24. PICKENS

25. PIKE

26. TALLADEGA

27. TUSCALOOSA

28. WINSTON

29. Clinical Rules

30. Initial focus on TFQ performance measures • Asthma • Diabetes • Alerts and Flags – Actionable • Additional “flags” for some labs and depression screening • Immunizations – IMMPrint CLINICAL RULES

31. User Acceptance Testing of Q tool • Continued Pilot Provider Recruitment • Follow-up and Monitoring • Measure progress providers, care managers, county • Feedback, Review and Modifications • Chronic Care Management Process • Issue Identification and Resolution • Finalization of External Evaluation Process Next Steps Inch by Inch, Step by Step