Monitoring clinical quality in Medicaid managed care.
With the recent exponential growth in managed-care plan enrollment by Medicaid beneficiaries, a variety of quality monitoring systems have emerged. This paper argues that existing quality monitoring systems, originally designed for use by employers in the private sector, are a useful starting point for quality monitoring in the Medicaid program, but that substantial enhancements are needed to provide adequate quality assurance for Medicaid beneficiaries. This paper describes the development of a range of indicators for monitoring the clinical aspect of the quality of care for Medicaid beneficiaries and offers a framework for adapting existing monitoring systems to the needs of the Medicaid population. This work is part of a larger collaborative effort by the Connecticut Department of Public Health and the Department of Epidemiology and Public Health of Yale University School of Medicine to develop a blueprint for state government's role in quality assessment and performance management for managed care.
Bradley
E H
EH
Department of Epidemiology and Public Health, Yale University School of Medicine, USA.
Horwitz
S M
SM
Grogan
C M
CM
Roberto
M
M
D000328:Adult; D002675:Child, Preschool; D003237:Connecticut; D005260:Female; D017408:Guidelines as Topic; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D008329:Managed Care Programs / Q000458:organization & administration / Q000592:standards*; D008484:Medicaid / Q000458:organization & administration / Q000592:standards*; D011247:Pregnancy; D016730:Program Development; D011785:Quality Assurance, Health Care / Q000458:organization & administration / Q000592:standards*; D019984:Quality Indicators, Health Care / Q000592:standards*; D014481:United States