Quality management practices in Medicaid managed care - A national survey of Medicaid and commercial health plans participating in the Medicaid program

Context Rapid expansion of Medicaid managed care has raised concerns about the capacity and willingness of health plans enrolling Medicaid beneficiari es to provide high-quality care. Recently, legislation has facilitated mark et entry of Medicaid plans, health plans that draw most of their enrollment from the Medicaid; population. Objective To characterize and compare the organizational characteristics an d programs related to quality of care of commercial and Medicaid health pla ns that participate in the Medicaid program. Design Cross-sectional survey conducted September 1997 to April 1998. Setting The Medicaid program in 11 states and the District of Columbia. Participants All 154 health plans in these localities that provided prepaid general medical care to Medicaid beneficiaries during June 1997, of which 130 (84%) responded to the survey. Main Outcome Measures Health plan reports of structural characteristics, se rvices offered, performance measurement and feedback, disease management pr ograms, information systems capabilities, and provider network composition and relationships. Results Half of the respondents were Medicaid plans, with 75% or more of en rollees drawn from the Medicaid population. Medicaid plans tended to be sma ller and newer than commercial plans that also served the Medicaid populati on and had more enabling programs targeting the special needs of the Medica id population, such as inadequate transportation (85% of Medicaid plans vs 62% of commercial plans; P =.003) and illiteracy (66% vs 38%, respectively; P =.002). Overall, 71% of Medicaid plans vs 43% of commercial plans had en abling programs targeted at 6 or more of the 8 special needs we specified ( P =.001). While commercial plans had a higher proportion of board-certified primary care physicians (81% vs 73%; P =.01), we found no major difference s between Medicaid plans and commercial plans in collection and disseminati on of performance measures, designation of specific areas for quality impro vement, or use of disease management programs targeted at conditions preval ent in the Medicaid population. Neither commercial nor Medicaid plans repor ted high success in improving quality of care. Conclusions Based on our survey, while Medicaid plans resemble commercial p lans serving the Medicaid population in many aspects of quality management, they are more likely to target programs directed to the specific needs of the Medicaid population. Neither commercial nor Medicaid plans have notably strong records in actual quality improvement.