Smith WR, Cotter J, Lewis CL, Rossiter LF.
AHSR FHSR Annu Meet Abstr Book. 1995; 12: 17.
Department of Internal Medicine, Medical College of Virginia/Virginia Commonwealth University, Richmond 23298-0102, USA.
PROBLEMS AND OBJECTIVES. This session contrasts the traditional utilization review-oriented Medicaid quality assessment with an approach more appropriate for Medicaid managed care. The session shows how one state, Virginia, in a new program funded by the Virginia Department of Medical Assistance Services, intends to continuously improve Medicaid managed care quality. It provides preliminary results of the program's immunization rates and consumer satisfaction. It highlights the program's methodology and philosophy. DATA AND METHODS. The program uses administrative claims data, state health databases, consumer surveys and provider records. It compares three payment structures: fee-for-service, primary care case management and capitation. RESULTS AND CONCLUSIONS. As a result of rapidly increasing Medicaid managed care participation, Medicaid quality assessment must undergo a paradigm shift. Preliminary results show varying consumer satisfaction and low immunization rates. This suggests that avoidance of underutilization rather than overutilization should be the focus of managed care quality efforts. Various data sources can be combined to create a comprehensive quality database that minimizes administrative burden on providers. IMPLICATIONS FOR THE AUDIENCE. Managed care policy makers must pursue production-based goals to improve quality and avoid over-reliance on market-based report card strategies. To do so, they may need to change methods of quality assessment. One potential peril of Medicaid managed care is a parallel reduction in quality as costs are reduced. New quality assessment methodologies may avoid this peril.
Publication Types:
Keywords:
- Case Management
- Fee-for-Service Plans
- Health Services Needs and Demand
- Managed Care Programs
- Medicaid
- Utilization Review
- Virginia
- economics
- methods
- hsrmtgs
Other ID:
UI: 102216036
From Meeting Abstracts