December 2, 2014

State of Alabama
Press Release: Medicaid

Improved health outcomes the goal for RCO incentive measures

Medicaid’s planned Regional Care Organizations will not only assume the financial risk of providing health care, they will also be responsible for improving enrollees’ health outcomes once the new system is underway.

To that end, agency officials announced 10 measures that will be incentivized under the new managed care system at a November 19 meeting of the RCO Quality Assurance Committee. 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.
“When the concept of Regional Care Organizations was developed, state officials were emphatic that the new system of care not only maximize taxpayer dollars, but do so in a way that improves health outcomes for Medicaid recipients,” said Medicaid Medical Director Dr. Robert Moon.
The 10 measures are a subset of 42 measures unanimously approved by the QA Committee earlier this year. All 42 measures will be used for monitoring RCO performance, but the ten will be used in the incentive program.  All but one of the 42 measures are nationally recognized and validated that will allow Alabama to compare its performance to other states and national benchmarks.

The measures not only include nationally-recognized metrics related to diabetes, asthma, maternity care, cervical cancer screening and well-child care, but assessments of care transition and coordination, mental and behavioral health and if care is provided in the most appropriate location. Click here to see a list of measures.

“The inclusion of mental and behavioral health measures is significant and affirms our long-held belief that social and behavioral health issues cannot be separated from physical health,” Dr. Moon said.

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.

Click here for more on the measures and the work of the QA Committee.

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