Author Affiliations: Department of Health Policy and Management, Harvard School of Public Health (Dr Epstein); the Section of Health Services and Policy Research, the Division of General Medicine, Brigham and Women's Hospital (Dr Epstein); the Department of Health Care Policy, Harvard Medical School (Drs Landon and Epstein); and the Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center (Dr Landon), Boston, Mass.
Policy Perspectives Section Editors: Robert
Blendon, ScD, Harvard School of Public Health, Boston, Mass; Drummond Rennie,
MD, Deputy Editor (West), JAMA.
Context Rapid expansion of Medicaid managed care has raised concerns about the
capacity and willingness of health plans enrolling Medicaid beneficiaries
to provide high-quality care. Recently, legislation has facilitated market
entry of Medicaid plans, health plans that draw most of their enrollment from
the Medicaid population.
Objective To characterize and compare the organizational characteristics and programs
related to quality of care of commercial and Medicaid health plans that participate
in the Medicaid program.
Design Cross-sectional survey conducted September 1997 to April 1998.
Setting The Medicaid program in 11 states and the District of Columbia.
Participants All 154 health plans in these localities that provided prepaid general
medical care to Medicaid beneficiaries during June 1997, of which 130 (84%)
responded to the survey.
Main Outcome Measures Health plan reports of structural characteristics, services offered,
performance measurement and feedback, disease management programs, information
systems capabilities, and provider network composition and relationships.
Results Half of the respondents were Medicaid plans, with 75% or more of enrollees
drawn from the Medicaid population. Medicaid plans tended to be smaller and
newer than commercial plans that also served the Medicaid population and had
more enabling programs targeting the special needs of the Medicaid population,
such as inadequate transportation (85% of Medicaid plans vs 62% of commercial
plans; P = .003) and illiteracy (66% vs 38%, respectively; P = .002). Overall, 71% of Medicaid plans vs 43% of commercial
plans had enabling programs targeted at 6 or more of the 8 special needs we
specified (P = .001). While commercial plans had
a higher proportion of board-certified primary care physicians (81% vs 73%; P = .01), we found no major differences between Medicaid
plans and commercial plans in collection and dissemination of performance
measures, designation of specific areas for quality improvement, or use of
disease management programs targeted at conditions prevalent in the Medicaid
population. Neither commercial nor Medicaid plans reported high success in
improving quality of care.
Conclusions Based on our survey, while Medicaid plans resemble commercial plans
serving the Medicaid population in many aspects of quality management, they
are more likely to target programs directed to the specific needs of the Medicaid
population. Neither commercial nor Medicaid plans have notably strong records
in actual quality improvement.
Landon BE, Epstein AM. Quality Management Practices in Medicaid Managed CareA National Survey of Medicaid and Commercial Health Plans Participating in the Medicaid Program. JAMA. 1999;282(18):1769-1775. doi:10.1001/jama.282.18.1769