Quality Management Strategies in Medicaid Managed Care: Perspectives From Medicaid, Plans, and Providers

Abstract

Medicaid managed care allows Medicaid beneficiaries to receive services through contractual relationships between managed care organizations and state Medicaid offices. Medicaid offices monitor quality of care, and many states encourage or require plans to adopt quality management practices. This research examines quality management in Medicaid managed care from the perspectives of Medicaid officials, managed care plan representatives, and providers through 25 qualitative interviews in one Northeastern state. Plan representatives described quality management efforts as robust and discussed strategies targeting providers and beneficiaries. Medicaid officials indicated motivations for plans to be responsible for quality management. Providers were unaware of plan efforts or reported them to be counterproductive since performance data were thought to be inaccurate or limited, and modest incentive programs presented excessive administrative burden. Providers’ general skepticism about managed care plans’ quality improvement efforts may hinder their effectiveness, cause frustration, and lead to administrative burden that may harm care quality.

Plan Switching and Stickiness in Medicare Advantage: A Qualitative Interview With Medicare Advantage Beneficiaries

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“…15 At the state level, Medicaid managed care organizations have extensive experience monitoring and improving the quality of care provided to beneficiaries in various settings. 16 In taking new steps to inform decisions about care in VA and community settings, VA should build on its own track record of monitoring care quality as well as the experiences of these and other payers in promoting informed decision-making and, where possible, build partnerships to leverage existing systems that will be useful to Veterans and VA clinicians in their decision-making.…”