Quality Improvement

Alabama’s Medicaid Program faces significant challenges related to quality, access, and cost of health care services. By offering incentives through a new payment model and addressing these challenges, the Alabama Medicaid Agency expects quality improvement efforts to reduce costs related to preventable admissions, readmissions, and emergency department (ED) utilization and rationalize care delivery to the most efficient and appropriate care setting.

The goals of ACHNs are to foster and encourage innovation, improvement, and clinical transformation at the care delivery level. Through the ACHN Program, the Alabama Medicaid Agency aims to accomplish the following objectives:

Improve care coordination and reduce fragmentation in the State’s delivery system
Create aligned incentives to improve beneficiary clinical outcomes
Improve access to health care providers
Reduce the rate of growth of Medicaid expenditures

The ACHN Program utilizes a value-based purchasing (VBP) strategy that aligns incentives for the State, ACHN, providers, and enrollees to achieve the Program’s overarching program objectives.

Source: Adapted from the Alabama Medicaid ACHN Quality Strategy

Select a topic below to learn more:

The Alabama Medicaid Agency has identified eight (8) provider measures for quality improvement; four (4) adult measures and four (4) child measures. Practices are either pediatric only, adult only, or both. The practice will need to identify which measures, child and/or adult, apply to the practice. This information is available on the practice’s Attribution Report located in the Alabama Medicaid Provider Portal. For additional questions, please contact the Alabama Medicaid Agency or North Alabama Community Care.

To qualify for a PCP Bonus Payment, actively participating practice must meet or exceed the provider measure benchmarks set by the Alabama Medicaid Agency:

*Benchmarks current as of August 2022. Please visit Alabama Medicaid’s Provider Page to confirm benchmarks, as these may have changed.

Select an option below to view guidelines

The Quality Measure and Cost Effectiveness Scorecards contain the information used to calculate your PCP Bonus Payments.

The Quality Measure Scorecard contains the practice’s score on each Quality Measure and whether the practice met the target.

The Cost Effectiveness Scorecard contains the information used to calculate the practice’s cost-effectiveness. Alabama Medicaid uses MARA (Milliman Advance Risk Adjusters) to determine risk scores for each Medicaid recipient.

Providers can access their scorecards in the Alabama Medicaid Provider Portal.

After logging into the portal, select TRADE FILES then DOWNLOAD
This should bring up the FILE DOWNLOAD SEARCH
Under TRANSACTION TYPE, select the report you would like to review and click SEARCH
By clicking on one of the reports under CURRENT REPORTS AVAILABLE FOR DOWNLOAD, it should automatically download to your computer and be available for viewing. Available reports are listed from newest to oldest.

There are four (4) reports that pertain to Quality Measures and Cost Effectiveness. In addition to the Scorecards, the Supplemental Member Summary File is available to download. This file contains all Medicaid Recipients attributed to the practice that were included in the calculations and the measures attributed to them.

MGD-S363-Q: Provider Profiler Quality Measure Scorecard
MGD-M363-Q: Provider Profiler Supplemental Member Summary File – Quality Measures
MGD-S365-Q: Provider Profiles Cost Effectiveness Scorecard
MGD-M365-Q: Provider Profiler Supplemental Member Summary File – Cost Effectiveness