Medicaid managed care and high quality: can we have both?

Article Abstract:

Efforts are being made to ensure that Medicaid patients in managed care organizations continue to receive good quality care. As of June, 1996, 13 million Medicaid recipients were enrolled in managed care. The financial incentives most managed care organizations have to reduce costs may impact Medicaid patients more severely than privately insured patients. In 1991, the Health Care Financing Administration initiated the Quality Assurance Reform Initiative to improve the quality of services provided to Medicaid managed care patients. The 1997 HEDIS database also includes performance measures for these patients.

Medical care, Medical care quality

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Quality management by state Medicaid agencies converting to managed care: plans and current practice

Article Abstract:

Many state Medicaid agencies that participate in managed care health plans have begun monitoring the quality of care provided to beneficiaries. Federal and state guidelines require quality assessment for Medicaid, which provides health care services to the poor and disadvantaged. Researchers surveyed the 34 states that enrolled Medicaid beneficiaries in managed care plans in 1995 and 1996, and found 63% monitored patient satisfaction. Many states planned expanded quality assessment, and 83% monitored childhood immunization rates.

Research, Patient satisfaction

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Quality Management Practices in Medicaid Managed Care: A National Survey of Medicaid and Commercial Health Plans Participating in the Medicaid Program

Article Abstract:

Medicaid managed care plans are more likely to provide services that target the specific needs of the Medicaid population compared to other managed care plans. This was the conclusion of a survey of 154 health plans in 11 states and the District of Columbia. Half of the plans were Medicaid plans, with people on Medicaid making up 75% or more of their enrollees. Over 70% had programs targeting the special needs of the Medicaid population, compared to 43% of the other managed care plans.

Services

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