Quality oversight and improvement in Medicaid managed care.
New York State has been collecting performance data from managed care plans that serve the Medicaid population since 1993. The data come to the state via the Quality Assurance Reporting Requirements--a series of quality of care, access, and utilization measures, largely based on the Health Plan Employer Data and Information Set, as well as several New York State-specific measures. In addition to collecting the data, the state publishes the information, works with plans that have below average rates of performance and provides a number of program and financial rewards to plans for rates that demonstrate high quality care. An analysis conducted on quality of care measures indicates that: (1) performance rates are increasing over time, (2) Quality Assurance Reporting Requirements rates are generally higher than national benchmarks, (3) the disparity between commercial plan rates and Medicaid rates is diminishing, and (4) the variability in performance across plans is decreasing. The analysis conducted indicates that the performance measurement system constructed in New York is an effective means to monitor health plan performance, while at the same time enabling the state and local health units to monitor population health and accomplishment of key public health objectives (complete immunization, cancer screening, etc.)
Roohan
Patrick J
PJ
Bureau of Quality Management and Outcomes Research, Office of Managed Care, New York State Department of Health, Corning Tower Room 1938, Empire State Plaza, Albany, NY 12237, USA. PJR02@health.state.ny.us
Anarella
Joseph P
JP
Gesten
Foster C
FC
D003625:Data Collection; D008329:Managed Care Programs / Q000592:standards*; D008484:Medicaid / Q000592:standards*; D009518:New York; D011050:Policy Making; D017749:Total Quality Management / Q000706:statistics & numerical data / Q000639:trends*; D014481:United States