Putting Measurement to Work: Improving the Quality of Health Care Delivered to Adults

Can Quality Be Improved Without MCOs?

Presenters: Jeffrey Simms, Assistant Director, North Carolina Division of Medical Assistance. Dr. Timothy Clifford, Medical Director, Maine Bureau of Medical Services. Ms. Jude Walsh, Director, Maine Quality Improvement Division.

Managed care organizations (MCOs) serve as responsible entities to improve the care delivered to adults. But not all adults receive their care from MCOs, and some States have developed strategies to improve the care delivered by primary care case management (PCCM) programs and through fee-for-service.

Mr. Simms, Assistant Director of North Carolina's Medicaid program, explained that his State's PCCM program partners with hospitals and primary care providers (PCPs) to:

• Improve quality and cost effectiveness.
• Promote community based systems of care.
• Enhance patient management for Medicaid beneficiaries.

The partners are working together to identify common goals and measures of success for asthma, diabetes, gastroenteritis, and Attention Deficit/Hyperactivity Disorder (ADHD). They have already shown improvement in some asthma outcomes and are developing consensus regarding diabetes management.

North Carolina found that:

• Developing consensus among the partners was difficult.
• Outcome measures were difficult to produce from Medicaid claims data.
• Funding for quality efforts is hard to maintain during times of tight budgets.
• Improvement takes time.

But the State has also found that it can work through these issues to produce real improvements in care. For example, the number of asthma patients with documented staging increased from 43 to 57 percent under this program.

Maine found providing feedback to PCPs improved performance, according to Dr. Clifford, Medical Director of Maine's Medicaid program, and Ms. Jude Walsh, Director of Maine's Division of Quality Improvement. In collaboration with physicians, the State developed the Primary Care Physician Incentive Program (PC-PIP).

Each quarter, PCPs receive a report comparing their performance to other PCPs of the same specialty. They receive an aggregate score based on performance on selected measures of access, emergency room use, and prevention and quality. If a PCP's aggregate score is in the top 20th percentile, the physician receives a bonus payment. Dr. Clifford and Ms. Walsh report that the incentive payment produces results, but that simply reporting and comparing performance also encourages improvement.

Current as of October 2002

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Internet Citation:

Putting Measurement to Work: Improving the Quality of Health Care Delivered to Adults. Workshop Brief, October 17-19, 2001, User Liaison Program. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/ulp/measure/ulppmtw.htm

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