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Innovations
Capitated System Identifies, Screens, and Treats Osteoporosis Risks, Preventing Hip Fractures, Saving Lives, and Reducing Costs 4/23/2014
A capitated system proactively identifies, screens, and treats those with or at risk for osteoporosis, leading to a 49 percent decline in hip fractures, more than 350 lives saved each year, and tens of millions of dollars in annual cost savings.
Medicaid Managed Care Plan Provides Reports, Guidelines, and Education Materials to Physicians, Reducing Inappropriate Prescribing of Antibiotics to Children and Adolescents 4/23/2014
As part of a collaborative, a California health plan provides quarterly provider performance reports, educational materials, and other support to physicians and parents, leading to a reduction in inappropriate prescribing of antibiotics to children, adolescents, and adults with an upper respiratory infection or acute bronchitis enrolled in the insurer's Medi-Cal managed care plan.
Policy State Medicaid Program Adopts Multiple Policies to Significantly Increase Screening Rates and Enhance Access to Services for Young Children at Risk of Developmental Disabilities 4/23/2014
The Oregon Health Authority (which oversees the State Medicaid program) initiated a series of policy changes to promote earlier detection, more effective referrals, and better coordination of care for pediatric patients with developmental delays, leading to a significant increase in screening rates and enhanced access to early intervention services.
Health Plan and Psychiatric Hospitals Reduce Readmissions by Reviewing Data and Developing Strategies to Improve Postdischarge Care 4/9/2014
A partnership between a health plan and psychiatric hospitals focuses on sharing of quarterly data, case reviews, and deployment of specific strategies to improve postdischarge care, leading to significant reductions in readmissions, inpatient days, and costs.
Medicaid Plan Offers Diabetic Patients Access to Fitness Facilities and Coaching, Leading to Weight Loss and Improvements in Cholesterol and Blood Glucose 4/9/2014
Medicaid managed care enrollees with type 2 diabetes receive free access to YMCA facilities and have regular meetings with nurses, dietitians, and personal trainers that focus on diet, exercise, and other aspects of disease self-management, leading to weight loss and improvements in body mass index, cholesterol, and blood glucose control.
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QualityTools
Health Insurer Pandemic Influenza Planning Checklist 3/12/2014
The Health Insurer Pandemic Influenza Planning identifies important, targeted activities health insurers can do now to prepare for a pandemic. This checklist is organized according to business-related, employee-related, and communications-related activities.
Designing and Implementing Medicaid Care Management Programs: A User’s Guide 12/18/2013
The Medicaid Care Management Guide helps States design, implement, and evaluate care management programs for the chronically ill.
Theory and Reality of Value-Based Purchasing: Lessons from the Pioneers 11/6/2013
This report summary provides early lessons on the scope, patterns, barriers, and possibilities of value-based purchasing.
Evaluating the Impact of Value-Based Purchasing: A Guide for Purchasers 10/9/2013
This guide was developed to be an evaluation tool for purchasers, particularly employers, in assessing their value-based purchasing (VBP) activities.
Medicare Prescription Drug Plan Finder 10/9/2013
This tool will help Medicare beneficiaries learn more about the new Medicare prescription drug coverage and enable them to find and compare prescription drug plans that meet their personal needs.

Last updated: April 23, 2014.