The Business Case for Quality: Phase II (BCQ II) was the second phase of CHCS’ efforts to assess whether quality improvement activities can generate financial savings in excess of program costs for various stakeholders in the health care system. The original BCQ demonstration, launched in April 2004, tested the existence of a business case for quality for Medicaid managed care organizations across a range of clinical conditions. BCQ II focused specifically on high-risk childhood asthma to develop rigorous evidence of interventions that improve quality and reduce costs.

BCQ II was designed to deliver robust and actionable results through its: 1) focus on a single disease – high-risk childhood asthma; 2) rigorous study design; 3) measurement of clinical quality; and 4) business case analyses for multiple-stakeholders. It sought to identify financing misalignments that impede investments in quality as well as strategies for correcting them.

Three grantees were competitively chosen to participate in the four-year initiative. Each of the participating organizations (see summaries below) received training and technical assistance on quality improvement, program evaluation, and return on investment analysis, as well as seed grants for participation. An evaluation of the BCQ II demonstration projects was conducted by Mathematica Policy Research and UNC. By evaluating the potential for chronic care management interventions to improve quality and reduce costs, BCQ II was designed to help determine whether investments in quality are financially sustainable across all levels of the health care system.

For more information, see The Business Case for Quality: Still Searching for the Slam Dunk.

Grantee Project Summaries

  •  Alameda Alliance for Health is a Medi-Cal (Medicaid) managed care plan serving Alameda County, California. Through partnership with the Children’s Hospital & Research Center – Oakland, the Alameda County Health Department, the American Lung Association of California and local provider groups, Alameda implemented an intervention known as Asthma Tools and Training Advancing Community Knowledge (ATTACK), designed to promote patient assessment, education, and self management through a multi-pronged approach. Following an emergency department visit for asthma, children were referred to an adjacent ATTACK clinic for follow-up. During this visit, a physician or nurse practitioner conducted an asthma assessment, provide treatment and one-on-one education, and develop an asthma action plan for the child and parent/guardian. In addition, via an onsite case worker, families were linked to community resources including home-based case management, school-based self-management education, and assistance in establishing a medical home.
  • Cincinnati Children’s Hospital Medical Center (CCHMC), a leading children’s hospital and research center in Cincinnati, Ohio, led a multi-stakeholder collaborative effort including CareSource, Amerigroup, provider groups, and local school systems. Through this initiative, CCHMC sought to eliminate asthma-related admissions and emergency department/urgent care visits for all children ages 2 to 17 with asthma in Hamilton County with Medicaid coverage by July 31, 2013.  The intervention included three components: 1) care coordination, with an initial focus on the inpatient to outpatient transition; 2) self-management support, through community-based case management; and 3) reduction of physical and social environmental barriers to care through risk assessments and linkages with community supports.  A patient registry, accessible by providers and patients/families, was used to monitor progress, identify just-in-time “failures” (i.e., acute exacerbations), and implement evidence-based interventions.
  • Monroe Plan for Medical Care is a Medicaid managed care plan serving Rochester, New York and surrounding communities.  In partnership with the New York State Department of Health and several regional health care delivery networks, the Monroe Plan implemented a pay-for-performance initiative to improve care for children with asthma.  Through a series of previous initiatives, the Monroe Plan already developed and implemented quality improvement programs that involve primary care practices in developing asthma action plans, educating patients and their parents, and coordinating care.  The new initiative built on Monroe Plan’s past experience by aligning financial incentives to potentially increase provider compliance with evidence-based asthma guidelines. Providers in participating clinics received payments for providing enhanced asthma care, including use of asthma action plans and self-management education.