November 1, 1999
Arnold M. Epstein, Bruce Landon
"Quality Management Practices in Medicaid Managed Care," Bruce Landon and Arnold Epstein, Journal of the American Medical Association 282, 18 (November 1999): 176975
The rapid expansion of Medicaid managed care has raised concerns about the ability and willingness of health plans that enroll Medicaid beneficiaries to provide high-quality care to their patients. Recent legislation that repealed federal rules requiring plans serving the Medicaid population to draw a certain percentage of their enrollees from the privately insured market has generated further controversy.
A study recently published in the Journal of the American Medical Association compared the quality management programs established by health plans that serve Medicaid beneficiaries. In "Quality Management Practices in Medicaid Managed Care" (Nov. 10, 1999), Bruce Landon, M.D., and Arnold Epstein, M.D., both of Harvard University, report on the results of a survey of 154 such health plans in 11 states and the District of Columbia. The authors highlight three notable findings:
- "Medicaid plans" (health plans whose enrollment is at least 75 percent Medicaid beneficiaries) are more likely than "commercial plans" (plans with a greater mix of commercially insured and Medicaid patients) to establish programs that address the special needs of the Medicaid population. These include programs targeting illiteracy, trans-portation difficulties, and poor nutrition.
- Quality improvement efforts, including performance measurement and case management, have been widely implemented by commercial and Medicaid plans alike. However, no major differences were found in the collection and dissemination of quality performance measures, designation of specific areas for quality improvement, or use of disease management programs targeted at conditions prevalent in the Medicaid population. Neither commercial nor Medicaid plans reported high success in improving quality of care.
- In their use of quality measures and other nonfinancial measures of performance to adjust compensation for physicians, the two types of plans were fairly similar. Commercial plans, however, had a higher proportion of board-certified primary care physicians.
Given that commercial plans are generally larger, older, and better capitalized than their Medicaid counterparts, they might be expected to possess more sophisticated quality management and information systems. The study findings indicate, however, that such systems are now common among plans, regardless of type. The findings further suggest that contractual requirements instituted by state Medicaid agencies have been successful in setting a minimum standard for quality management.
Facts and Figures
- Overall, 71 percent of Medicaid plans, versus 43 percent of commercial plans, had programs for their Medicaid-insured patients that targeted six or more of eight special needs.
- Medicaid plans were more likely than commercial plans to have a HIV/AIDS program (38% vs. 25%), while commercial plans were more likely to have a diabetes program (75% vs. 55%).
- Seventy-seven percent of Medicaid plans required their physicians to care for Medicaid patients, compared with only 28 percent of commercial plans.