Monitoring quality in Medicaid managed care: Accomplishments and challenges at the year 2000

摘要

This paper reviews the major developments during the late 1990s in quality monitoring for Medicaid managed care and offers an assessment of major challenges faced at the year 2000. We highlight the dramatic increase in activities to ensure and improve quality in Medicaid managed care. Prior to these developments, little was known about the actual level of quality of care. Thus, a major accomplishment of the late 1990s is that we now know more about quality, through some key indicators, and that states and plans have implemented activities and structures designed to improve quality. Despite this achievement, there is still a critical gap in our understanding about which activities and structures effectively improve the health of beneficiaries. There are also three operational challenges. First, as state quality assurance and improvement systems become increasingly comprehensive, states are challenged to keep them well coordinated and well targeted to key issues. Second, the dynamics of both plan turnover and enrollment—including steep drops in Medicaid enrollment—present a challenge for measuring and improving quality. A third challenge is to ensure that quality assurance and improvement programs work for enrollees with special health care needs. Finally, devoting sufficient resources to quality monitoring and improvement is a challenge for both states and plans since managed care programs are expected to save money as well as improve quality.