Quality oversight in medicaid primary care case management programs.
As health maintenance organizations (HMOs) have curtailed participation in Medicaid, enrollment in primary care case management (PCCM) programs has grown. To examine state Medicaid agencies' monitoring of PCCM and HMO programs, we surveyed Medicaid agency directors of forty-six states and the District of Columbia. Agencies were less likely to collect performance data in PCCM programs than in HMO programs. Few PCCM programs reported performance results for the public or providers. Reporting states tended to emphasize utilization results over quality-measure results. Despite growing enrollment, PCCM programs appear less likely to use the quality-oversight strategies employed by Medicaid health plans.
Schneider
Eric C
EC
Department of Health Policy and Management, Harvard School of Public Health, Cambridge, MA, USA. eschneid@hsph.harvard.edu
Landon
Bruce E
BE
Tobias
Carol
C
Epstein
Arnold M
AM
D019090:Case Management; D014487:Centers for Medicare and Medicaid Services, U.S.; D006279:Health Maintenance Organizations; D006801:Humans; D008484:Medicaid / Q000592:standards*; D011320:Primary Health Care / Q000592:standards*; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data; D011787:Quality of Health Care; D014481:United States