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Quality & Cost Effectiveness Targets

Medicaid Quality & Cost Effectiveness Targets

Section 43 of SB 74 adds AS 47.05.270 to the Medicaid statutes, creating the Medicaid Reform Program. This new section focuses on initiatives to improve the effectiveness and efficiency of health care expenditures while improving the quality of care received by Medicaid recipients. One requirement is that the Department work with stakeholders to help identify quality and cost effectiveness measures and targets for the Medicaid program that can be monitored and reported to help improve the overall quality of the Medicaid program and the services received by Medicaid recipients.

A 15-member stakeholder workgroup representing providers, provider organizations, consumers, and tribal health organizations was convened during Fiscal Year 2017 to support this initiative. The workgroup submitted their report to the Department in August 2017. Focused on overall program performance, the Medicaid Redesign Quality and Cost Effectiveness Targets Stakeholder Workgroup recommends in their report 18 program performance measures that can be monitored over the course of the next several years to evaluate gains in program quality. The workgroup considered numerous national measures before selecting the final 18 measures and then developing corresponding performance goals. In addition to the recommendations on performance measures and goals, the workgroup made five additional recommendations regarding adoption of future measures and data support essential for evaluating performance. The department will be analyzing the workgroup’s recommendations and developing strategies for moving forward. The workgroup report and the department’s response will be included in the department’s annual report on Medicaid redesign efforts that will be released in November 2017.

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Updated 12/04/18