Quality improvement in a primary care case management program.
In this article we describe and evaluate quality monitoring and improvement activities conducted by Massachusetts Medicaid for its primary care case management program, the primary care clinician plan (PCC). Emulating managed care organization (MCO) practices, the State uses claims to analyze and report service delivery rates on the practice level and then works directly with individual medical practices on quality improvement (QI) activities. We discuss the value and limitations of claims-based data for profiling, report provider perspectives, and identify challenges in evaluating the impact of these activities. We also provide lessons learned that may be useful to other States considering implementing similar activities.
Walsh
Edith G
EG
ewalsh@rti.org
Osber
Deborah S
DS
Nason
C Ariel
CA
Porell
Marjorie A
MA
Asciutto
Anthony J
AJ
D019985:Benchmarking; D019090:Case Management / Q000592:standards*; D006801:Humans; D008404:Massachusetts; D008484:Medicaid / Q000592:standards*; D009819:Office Visits; D010821:Physicians, Family / Q000145:classification / Q000193:education / Q000592:standards*; D011320:Primary Health Care / Q000592:standards*; D019984:Quality Indicators, Health Care; D013221:State Health Plans / Q000592:standards*; D017749:Total Quality Management / Q000458:organization & administration*; D014481:United States