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Improving the Quality of Care Delivered to Children Served by State Agencies

Coordinated Initiatives Improve Care


Tricia Leddy, M.S., Administrator, Center for Child and Family Health, Rhode Island Department of Human Services, Cranston, RI.

Tricia Schlechte, M.P.H., B.S.N., Deputy Director, Maternal, Child and Family Health Division, Missouri Department of Health, Jefferson City, MO.

Cathy Caldwell, M.P.H., Data Manager, Children's Health Insurance Program, Alabama Department of Public Health, Montgomery, AL.

In Rhode Island, multiple agencies have collaborated on several quality improvement projects:

  • The Department of Health and the Department of Human Services created a system that trends health outcomes and quality indicators for Medicaid beneficiaries compared to outcomes and indicators for individuals with private insurance or no insurance.
  • The Medicaid agency, the Departments of Health; Children, Youth, and Families; Education; and Mental Health created an initiative to improve access to and quality of care for children with special health care needs (CSHCN) enrolled in Medicaid by providing access to comprehensive assessment, referral, and ongoing care coordination.
  • The Department of Children, Youth, and Families, and the Department of Human Services have developed one delivery system for foster children, integrating health plan and child protection services and staff to improve the continuity and quality of care provided to children in foster care.

In Missouri, the Departments of Social Services, Mental Health, and Health created a system of health status indicators to measure MCO performance. The goals were to have ways of detecting problem areas as soon as possible and to ensure that Medicaid beneficiaries' health status would not suffer under managed care. The system uses birth certificate and hospital discharge databases.

The Alabama Governor's Task Force on Children's Health Insurance involves seven State agencies and other concerned parties. The Task Force is charged with:

  • Coordinating existing funds and efforts to determine how the State can best provide health insurance to children who are not otherwise eligible for Medicaid.
  • Developing a comprehensive strategy to expand Medicaid eligibility.
  • Developing a comprehensive strategy to reduce the percentage of children without health insurance.

Motivating factors for the parties to collaborate included:

  • Concerns that managed care would decrease quality of care.
  • Desire for hard data on access and utilization within managed care.
  • Resources (financial and in-kind) set aside for the effort.
  • Strong leadership commitment in the agencies involved.
  • Expressed desire of the Governor.

Factors that make each agency feel like an equal partner in sustaining collaborations include:

  • The activities further each agency's goals.
  • Each subcommittee is chaired by a representative of a different agency.
  • Early successes built trust.
  • Data sharing allowed State agencies to look at data that was quickly available from the Department of Health) and more detailed (from Medicaid encounter data).
  • State staff felt it was "the right thing to do."

Methods of involving providers in developing initiatives include.

  • Using representatives from the State medical association, hospitals, or primary care association on task forces and advisory committees.
  • Creating a special advisory committee composed of physicians. The committee meets when convenient or "piggy-backs" the meetings of an existing provider group so that participants in the advisory group are not forced to attend two meetings.
  • Using relevant information and small successes to garner the interest of particular sets of providers.

Benchmarks were chosen through various methods:

  • One State worked with a university to examine quality of care indicators for adolescents continuously enrolled in Medicaid.
  • One State examined available data to choose Healthy People 2010 goals in which it wanted to see change and believed that MCOs would have an impact.
  • In one State, a joint committee determined several major goals, then chose six indicators to measure their success in meeting those goals.

All three States had university connections to expand their data collection and analysis capacities. In one State, the university was jointly contracted by two agencies. One agency noted that university researchers often develop unique ways to look at the data. Another agency noted that university researchers can obtain grant funding for research projects that benefit the State.


All Kids, SOBRA Medicaid: Application for the Alabama Child Care Giving Foundation. Montgomery (AL): Department of Health and Human Services; 2000, Sep.

Children's Health Insurance Program: Preliminary recommendations of the Children's Health Insurance Program. Montgomery (AL): Alabama Department of Health; 1997, Sep.

Children's Health Insurance Program: Alabama Interagency Coordination: Biosketch and Packet. Montgomery (AL): Alabama Department of Health; 2000.

Schroeder SA. Letter to Governor of Alabama. Princeton (NJ): Robert Wood Johnson Foundation; 2000, Nov.

Siegelman D. Letter to National Governors' Association. Montgomery (AL): Office of the Governor; 2000, Sep.

State of Alabama: Executive Order Number 27. Montgomery (AL): Office of the Governor; 2000, Apr.

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