The "Nuts and Bolts" Behind Quality Measurement in Medicaid Managed Care
Quality measurement in Medicaid helps states and managed care plans ensure beneficiaries are receiving high value services that improve their health and wellbeing. To achieve this goal, quality measures must be well-tested, evidence-based, peer-reviewed, and focused on measuring outcomes for diverse populations and services.
As states continue to expand managed care enrollment and other delivery system reforms in Medicaid, quality measurement is critical to the evaluation of these efforts. States typically choose HEDIS® and oftentimes CAHPS® measures to monitor quality in Medicaid managed care, and most states require that health plans report other quality metrics that are relevant to state-specific initiatives, demographics, and covered benefits.
There is an abundance of quality metrics generally, but there are notable gaps in measures for behavioral health, long-term services and supports, and individuals with complex health needs (e.g., dual eligibles and individuals with multiple chronic conditions).
Related Public Policy Research
Balancing Standardization and State Flexibility in Medicaid Quality Measurement and Reporting
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.
The Impact of Medicaid Quality Rating Systems
Little is known about how quality tools impact managed care but the experience of other programs suggests that as tools evolve, their influence on behavior and plan quality could grow.