Improving the quality and cost-effectiveness of publicly financed health care
Standardizing Disease Management Reporting for a Multi-State Plan
Molina Healthcare, Inc., a rapidly growing health plan specializing in Medicaid and SCHIP, applied the BCAP Typology to develop a standardized approach to quality improvement for members with asthma and diabetes in California, Michigan, Utah, and Washington. A designated member from the health plan's quality improvement department in each state worked collaboratively with the director and chief medical officer to establish a uniform method for designing and monitoring quality improvement initiatives that could be adopted across all four plans. Previously, Molina's state plans each developed unique programs and measured different outcomes, making it difficult to compare data from plan to plan.
The BCAP Typology, developed by the Center for Health Care Strategies, is part of a larger, proven quality improvement process, the Best Clinical and Administrative Practices Quality Framework, which has been used by nearly 140 health plans nationally to drive quality improvement efforts.
"The BCAP Typology provides a consistent framework to measure, record, and track disease management efforts across all plans to determine what accounts for the differences in process and outcome measures from state to state," said Marian Ryan, corporate director of disease management and health education. "With standardized identification, stratification, and core intervention criteria in place we are able to identify the state plans that are achieving better results. We can then look further to examine the details of applied interventions to determine best practice strategies that may need to be incorporated throughout all programs. Without this ability, we couldn't make effective, evidence-based decisions about how to evolve our quality improvement programs."
In Molina's case, the first two steps in the BCAP Typology are taken at the corporate level: a corporate data repository identifies members with asthma and diabetes, and then stratifies members based on standardized criteria that presume disease severity. This information is imported monthly into Molina's single data platform (InformaCare®) for follow-up with core adopted outreach and member interventions. While core outreach and member interventions (BCAP Typology steps three and four) are adopted as part of the national program design, specific state contract requirements often result in slightly different applications within each state. Standardized process and outcome measurements allow Molina to identify best practice strategies within a state and allow comparison of results across plans.
A standardized reporting matrix was developed using the BCAP Typology and presented to the work group for adoption. While each state health plan collects additional measurements per specific state requirements, corporate analysts can disseminate this populated data matrix quarterly to each health plan. Measurements within the matrix include:
| Typology Category | Measure |
| Identification |
|
| Stratification |
|
| Outreach (to high risk) |
|
| Intervention |
|
Once all state health plans' matrices are populated from data gathered within the single data platform, the work group can discuss differences and similarities observed. Further discussion of findings and plan practice will identify best practice strategies for adoption across all states.
Prior to implementing the BCAP Typology into the disease management reporting for the four states involved, two of Molina's state-based plans had participated in BCAP workgroups: Molina Healthcare of Michigan is a member of two BCAP workgroups on Enhancing Early Child Development Services and Reducing Racial and Ethnic Disparities and Molina Healthcare of California was part of the BCAP California Asthma Collaborative. For the other health plans, the benefits of using the BCAP Typology to standardize reporting sold the concept.
"Fortunately, the BCAP Typology presented many benefits to the plans," said Ms. Ryan. "First, disease management is a reportable parameter, so the BCAP Typology simplified the data process for something plans were required to measure and report. Second, once we institutionalized this process at the corporate level, all of the data were pulled by the corporate statistician. State-based plans did not have to increase their local IS resources."
The next steps for Molina include incorporating cardiovascular disease into its disease management programs that are monitored using the BCAP Typology, and exploring the possibility of spreading this design and monitoring approach to other state-based Molina plans.
"Large organizations, especially those that operate out of more than one area, don't have the ability to compare disease management programs and identify the best interventions, without having some kind of standardized reporting structure," said Ms. Ryan. "Without that ability, it's impossible to make evidence-based decisions to evolve quality improvement programs. The BCAP Typology offers a consistent framework to compare operations and continue to work toward that best practice. This has improved Molina's disease management programs, which helps improve the health of our members."