Helping States Improve Quality of Care for Kids in Medicaid Managed Care

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<p>State Medicaid agencies typically contract with external quality review organizations (EQROs) to assess the quality of health services provided through Medicaid managed care plans. But as documented in previous Commonwealth Fund-supported research, only a handful of states are using these organizations to improve the quality of preventive and developmental services for young children. Often, the problem stems from a lack of guidance on ways to work effectively with EQROs.<br><br>In the new Fund report, <a href="/publications/fund-reports/2008/jun/monitoring-and-assessing-the-use-of-external-quality-review-organizations-to-improve-services-for-yo
">Monitoring and Assessing the Use of External Quality Review Organizations to Improve Services for Young Children: A Toolkit for State Medicaid Agencies</a>, a team of researchers at Mathematica Policy Research, Inc., and George Washington University shows state Medicaid officials how they can work with EQROs to evaluate and improve the quality of preventive and developmental services delivered to children enrolled in Medicaid managed care plans.<br><br>The researchers, led by Mathematica's Tara Krissik, M.P.P., and Henry Ireys, Ph.D., say state staff can use this guidance to: 1) generate ideas on what to include in a request-for-proposals (RFP) for a new contract, or in specifications for remaining work to be conducted under an existing contract; and 2) help judge submitted proposals. For example, states may wish to contract with EQROs to:<ul><li>determine a managed care plan's compliance with federal Medicaid regulations related to the Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) program</li><li>measure plan performance in the delivery of preventive and developmental services</li><li>assess a plan's information system related to preventive and developmental services</li><li>conduct a focused study on children's preventive and developmental services.</li></ul>"States have many compelling reasons for making long-term commitments toward improving the quality of these services for young children enrolled in Medicaid," the authors say. "Creating the infrastructure to monitor and assess the quality of preventive and developmental care can have a lasting impact on the health of children and their families, and thus on society as a whole."</p>