A great debate is under way over health care in America. While we have access to the world’s most advanced medical treatment, the health care system consumes a large share of the U.S. economy and leaves too many uninsured.
There is little national consensus over how to resolve all of the issues. However, a lot can be learned from state initiatives such as the Together for Quality (TFQ) program initiated by the Alabama Medicaid Agency (ALMA) with a federal grant.
State governments provide health coverage to the low-income population through Medicaid, and they have great experience in dealing with cost and quality issues. For years, ALMA has engaged primary care doctors who provide its beneficiaries with an effective “medical home,” or gateway into good medical care. TFQ builds on this foundation, using electronic information sharing to improve case management for Medicaid recipients with chronic illnesses such as diabetes and asthma.
The project takes advantage of the fact that most primary care doctors in Alabama participate not only in Medicaid but also in Blue Cross and Blue Shield, which is a TFQ partner. Hospital, medical and pharmacy claims, as well as laboratory results, from both sources are being made available to participating primary care doctors. In addition to having more complete information, these doctors are able to monitor compliance with treatment plans and order prescriptions electronically.
In the past, ALMA has been limited mostly to information on billing, but with TFQ, it is gaining the capacity to gather data on treatment outcomes for thousands of its beneficiaries. This will enable the agency to focus on improving treatment where the data show it is needed.
Currently TFQ is being piloted in 11 Alabama counties, with rollout to the rest of the state scheduled to begin this fall. The potential payoff from full implementation of TFQ is big since chronic illnesses account for an estimated 75 percent of all national health expenditures. A recent review of TFQ by The Commonwealth Fund, a private foundation that supports research, pointed to this potential, as well as lessons learned about introducing technology into medical practices on a large scale.
For information, visit www.medicaid.alabama.gov and click on the “Transformation” tab.
EDITOR’S NOTE — Jim Williams is executive director for the nonprofit, nonpartisan Public Affairs Research Council of Alabama.
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