The Impact of Medicaid Quality Rating Systems

October 2016
Full report Executive summary

Across health plans and programs, consumers are encouraged to use quality and transparency tools, but little is known about their impact in Medicaid managed care. The experience of other programs suggests that as Medicaid tools evolve, their influence on beneficiary behavior and plan quality could grow.

Medicaid managed care quality programs are evolving from measuring and reporting on quality to creating health plan rating systems that drive the purchase, delivery, and utilization of higher value care. Some states have developed tools to empower beneficiaries to more easily compare quality among health plans and select the highest value option.

As Medicaid managed care quality rating systems proliferate, a key question is whether these systems are successful in driving changes in consumer, health plan, and provider behavior. Although anecdotal evidence suggests that some consumers use the information provided, more research is needed to assess the impact of quality rating systems in Medicaid.

Topics

  • Evolution of quality rating systems
  • Federal role in managed care quality
  • State quality rating systems
  • Effectiveness of quality ratings systems
  • Impact of rating systems on behavior

Related Public Policy Research

The "Nuts and Bolts" Behind Quality Measurement in Medicaid Managed Care
October 2016
To ensure beneficiaries access high-value services, quality measures must be well-tested, evidence-based, peer-reviewed, and focus on outcomes for diverse populations and services.
Balancing Standardization and State Flexibility in Medicaid Quality Measurement and Reporting
October 2016
Efforts to reform Medicaid quality measurement should balance the benefits of standardization across states while maintaining the flexibility of states to innovate and address unique needs.

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