What Are Medicare Managed Care Plans Doing To Measure and Improve Quality of Care?

Abstract

To explore managed care plans' efforts to assess and improve quality of care for Medicare beneficiaries, the authors surveyed managed care plans with risk contracts for Medicare beneficiaries in 20 large metropolitan areas in January 1998. The survey inquired about: (1) the health plans' efforts to assess and improve quality of care for specific underuse, overuse, and misuse problems; (2) how the health plans assessed functional status of enrollees, and (3) the quality improvement program they believed had the greatest impact on the health of enrollees. The managed care plans reported a heterogeneous mix of quality improvement activities ranging from poorly developed to very sophisticated. The vast majority of the more sophisticated programs addressed problems with underuse of services rather than overuse or misuse.

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

“…Research from the late 1990s and early 2000s has qualitatively examined managed care efforts to promote quality for Medicaid patients enrolled in managed care plans (Becher, Halm, Lieberman, & Chassin, 2000; Cukor, Fairbrother, Tassi, Butts, & Friedman, 2002; Fairbrother, Friedman, Butts, Cukor, & Tassi, 2000; Landon, Schneider, Tobias, & Epstein, 2004; Landon, Tobias, & Epstein, 1998; Schneider, Landon, Tobias, & Epstein, 2004; Williams, Zaslavsky, & Cleary, 1999). Some studies have found that although managed care plans describe significant efforts to manage and improve care quality, knowledge of these efforts largely fails to reach providers and result in improved quality of care for patients (Cukor et al, 2002; Fairbrother et al, 2000).…”