KEYWORDS:
partnerships, quality, assessments, improvement strategies

BACKGROUND:
Developing partnerships between Managed Care Organizations (MCOs) and local
health departments along with Medicaid is a growing approach to improving
quality in medicaid practices. One such group developed within Cook County,
Illinois to address issues of quality and accountability among Medicaid managed
care providers in Chicago and the suburbs. Collaborators identified immediate, practical
steps for developing relationships that will contribute to improvements in health
care. They began with first measuring immunization rates and lead screening
documentation rates among private practices enrolled in each of the five plans.

OBJECTIVE(S):
To use the partnership to explore two areas of preventive health indicators, lead screening and current
rates of immunization, among managed care Medicaid providers and evaluate
overall results for common themes and problems.

METHOD(S):
This retrospective cohort study involved performing immunization assessments
among children enrolled in each of five Medicaid health plans in the metropolitan
area of Chicago, Illinois, using CASA. 1,611
children’s records between the ages of 12-35 months from 37 separate
health care providers were examined for various immunization coverage levels
and lead screening
documentation.

RESULT(S):
Aggregate results for all health plans reveals 54% of children 24-35 months of age
were up to date with immunizations at the 4:3:1 and 4:3:1:3 levels, while 68% of
children 12-23 months were up to date at the 3:2:2:2 level. Similarly, only 48%
of the 12-23 month olds had documentation of lead testing.

CONCLUSIONS(S):
Immunization rates and lead screening rates among this Medicaid managed care
population continue to be substantially lower than the stated goals of Healthy
People 2010 and Medicaid. Beyond these efforts, quality interventions will be
implemented to support higher rates among these providers. System wide
strategies are also being evaluated to help standardize procedures and simplify the
demands on these providers.

LEARNING OBJECTIVES:
1. Describe barriers to immunization among Medicaid providers.
2. Define quality and accountability issues for Medicaid Managed Care practices.
3. Understand process issues in collaborative partnerships.