Kaiser Foundation Examines Managed Care

The vast majority of states with Medicaid managed care plans (MCOs) now produce public reports on quality, according to a comprehensive survey just out from the Kaiser Commission on Medicaid and the Uninsured. Over three-fourths of the 36 states with MCOs publish quality reports, with 16 now producing actual “report cards.” All states with MCOs state that they require HEDIS® measure reporting as well as patient experience reporting. Almost half (16 of 36) require that plans be accredited by such groups as the National Commission for Quality Assurance, URAC or the Accreditation Association for Ambulatory Health Care. Under federal regulation, states with Medicaid managed care plans are obliged to engage the services of an independent External Quality Review Organization (EQRO), tasked with assessing plans’ compliance with access requirements as well as other responsibilities. EQROs also conduct clinical studies and examine plans’ performance improvement activities. These typically address such areas as improving birth outcomes, access to pediatric subspecialists, use of emergency rooms, smoking cessation and care coordination. IPRO currently holds EQRO contracts with the states of New Jersey, Louisiana, New York, Kentucky, Nebraska, Pennsylvania, and Rhode Island, as well as Puerto Rico. For a copy of “A Profile of Medicaid Managed Care Programs in 2010: Findings from a 50-State Survey,” visit the Kaiser Family Foundation’s website at www.kff.org.

HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).