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Special Edition: Title V Technical Assistance MeetingExpand Special Edition: Title V Technical Assistance Meeting
Title V Technical Assistance Meeting

 Application of Quality Improvement in Alaska's Medicaid Enrollment Process

​By Emily B. Vander Schaaf, MD, MPH
Research Fellow, Population Health Improvement Partners
Assistant Professor of Pediatrics, University of North Carolina at Chapel Hill

Greg Randolph, MD, MPH
President and CEO, Population Health Improvement Partners
Professor of Pediatrics and Public Health, University of North Carolina at Chapel Hill​

​Quality Improvement in Macrosystems

Quality improvement (QI) tools can improve patient care and outcomes by improving process. While much has  been written about the benefits of QI in microsystems (i.e., within one clinic, one health department or one hospital department), less is known about how QI can change health care delivery at the macrosystem, policy level. Here we describe the use of QI tools to assess and improve the Medicaid enrollment process in Alaska.

​Maternal and Child Health (MCH) Workforce Development Center

The National MCH Workforce Development Center and its expert partners offer states a number of platforms for training state leaders in four core areas of health transformation: quality improvement, access to care, change management and systems integration. In consultation with the Workforce Development Center, states determine which area(s) might best help them improve systems of care for their populations. 

Alaska’s Medicaid Enrollment Problem

Before Alaska implemented QI training, applicants to its Medicaid program suffered through long processing times, with the backlog of applications reaching approximately 10,000. Pregnant women needing medical care were especially vulnerable to these waits. Similarly, children and youth with special health care needs (CYSHCN) often require frequent specialty care and are in danger during periods of insurance coverage gaps. Knowing this, Alaska’s team used QI to evaluate and improve the Medicaid enrollment process for pregnant women and CYSHCN. 

Alaska’s Use of QI Tools 

In 2015, a core team of seven representatives from Alaska’s Division of Public Health received training and technical assistance from the National MCH Workforce Development Center, including assistance applying quality improvement tools from the QI Core (staffed by Population Health Improvement Partners). This team included staff who focus on maternal, child and family health as well as parent representatives. After an initial training at the University of North Carolina, a QI facilitator conducted training webinars and an on-site, two-day QI event. There, the team used value stream mapping to examine the process of Medicaid enrollment for CYSHCN and pregnant women. Using this QI tool, they identified the process by which these populations got enrolled in Medicaid, barriers to more prompt enrollment and opportunities to minimize these barriers. The team then gave a presentation to the state’s Medicaid leadership, suggesting that the state pilot modifications in the enrollment process for CYSHCN and pregnant women before implementing broader change. Impressed by the effects of value stream mapping, leadership elected instead to use it to evaluate the enrollment process for all Medicaid applicants before implementing broader change.

​Effects of QI Training

In semi-structured interviews, core team members credited their QI training for leadership’s subsequent motivation to use a similar process of value stream mapping to identify barriers to quick Medicaid enrollment for all Medicaid-eligible populations. As a result, changes are underway for the Medicaid enrollment process. Core team members described several additional benefits of the QI training: They expressed an increased collegiality between divisions of the Division of Public Health and better understanding of each other’s processes and frustrations. Some endorsed improving the understanding of QI tools and increasing their use in other projects and proposals. All members felt that value stream mapping was a valuable way of identifying process problems in order to create solutions.  

*Population Health Improvement Partners is a national leader in building community and organizational capacity to improve and sustain population health.​