Quality of Care in Medicaid Managed Care and Commercial Health Plans | Health Care Quality | JAMA | JAMA Network
[Skip to Navigation]
Access to paid content on this site is currently suspended due to excessive activity being detected from your IP address Please contact the publisher to request reinstatement.
Kaiser Family Foundation.  Trends and indicators in the changing health care marketplace, section 2: trends in health insurance enrollment. http://www.kff.org/insurance/7031/print-sec2.cfm. Accessed February 8, 2007
Centers for Medicare & Medicaid Services.  Medicaid managed care: overview. http://www.cms.hhs.gov/MedicaidManagCare/. Accessed February 8, 2007
Landon BE, Zaslavsky AM, Bernard SL, Cioffi MJ, Cleary PD. Comparison of performance of traditional Medicare vs Medicare managed care.  JAMA. 2004;291(14):1744-175215082702Google ScholarCrossref
Miller RH, Luft HS. Managed care plan performance since 1980: a literature analysis.  JAMA. 1994;271(19):1512-15198176832Google ScholarCrossref
Miller RH, Luft HS. Does managed care lead to better or worse quality of care?  Health Aff (Millwood). 1997;16(5):7-259314673Google ScholarCrossref
Landon BE, Huskamp HA, Tobias C, Epstein AM. The evolution of quality management in state Medicaid agencies: a national survey of states with comprehensive managed care programs.  Jt Comm J Qual Improv. 2002;28(2):72-8211838298Google Scholar
Landon BE, Schneider EC, Tobias C, Epstein AM. The evolution of quality management in Medicaid managed care.  Health Aff (Millwood). 2004;23(4):245-25415318586Google ScholarCrossref
Landon BE, Tobias C, Epstein AM. Quality management by state Medicaid agencies converting to managed care: plans and current practice.  JAMA. 1998;279(3):211-2169438741Google ScholarCrossref
Landon BE, Epstein AM. Quality management practices in Medicaid managed care: a national survey of Medicaid and commercial health plans participating in the Medicaid program.  JAMA. 1999;282(18):1769-177510568652Google ScholarCrossref
Epstein AM. Medicaid managed care and high quality: can we have both?  JAMA. 1997;278(19):1617-16219370510Google ScholarCrossref
Thompson JW, Ryan KW, Pinidiya SD, Bost JE. Quality of care for children in commercial and Medicaid managed care.  JAMA. 2003;290(11):1486-149313129989Google ScholarCrossref
National Committee for Quality Assurance.  HEDIS 2003. http://www.ncqa.org/Programs/HEDIS/HEDIS%202003%20Information.htm. Accessed February 8, 2007
Thompson JW, Pinidiya SD, Ryan KW.  et al.  Health plan quality-of-care information is undermined by voluntary reporting.  Am J Prev Med. 2003;24(1):62-7012554025Google ScholarCrossref
McCormick D, Himmelstein DU, Woolhandler S, Wolfe SM, Bor DH. Relationship between low quality-of-care scores and HMOs' subsequent public disclosure of quality-of-care scores.  JAMA. 2002;288(12):1484-149012243635Google ScholarCrossref
InterStudy Publications.  The Competitive Edge HMO Database. Bloomington, MN: InterStudy Publications; 2004
Scanlon DP, Swaminathan S, Chernew M, Bost JE, Shevock J. Health plan performance: evidence from managed care insurance markets.  Med Care. 2005;43(4):1-9Google ScholarCrossref
Chernew ME, Wodchis WP, Scanlon DP, McLaughlin CG. Overlap in HMO physician networks.  Health Aff (Millwood). 2004;23(2):91-10115046134Google ScholarCrossref
Scanlon DP, Chernew M, Swaminathanan S, Lee W. Competition in health insurance markets: limitations of current measures for policy analysis.  Med Care Res Rev. 2006;63:(6 suppl)  37S-55S17099129Google ScholarCrossref
Scanlon DP, Swaminathanan S, Chernew M, Lee W. Market and plan characteristics related to HMO quality and improvement.  Med Care Res Rev. 2006;63:(6 suppl)  56S-89S17099130Google ScholarCrossref
National Committee for Quality Assurance.  The state of health care quality 2006. http://web.ncqa.org/Portals/0/Publications/Resource%20Library/SOHC/SOHC_2006.pdf. Accessed April 6, 2007
Centers for Disease Control and Prevention.  Chlamydia trachomatis genital infections–United States, 1995.  MMWR Morb Mortal Wkly Rep. 1997;46(9):193-1989072679Google Scholar
Centers for Disease Control and Prevention.  What complications can result from untreated chlamydia? http://www.cdc.gov/std/Chlamydia/STDFact-Chlamydia.htm#complications. Accessed April 6, 2007
Agency for Healthcare Research and Quality.  AHRQ national healthcare disparities report 2005. http://www.ahrq.gov/qual/nhdr05/nhdr05.htm. Accessed February 8, 2007
Bach PB, Pham HH, Schrag D, Tate RC, Hargraves JL. Primary care physicians who treat blacks and whites.  N Engl J Med. 2004;351(6):575-58415295050Google ScholarCrossref
Zaslavsky AM, Hochheimer JN, Schneider EC.  et al.  Impact of sociodemographic case mix on the HEDIS measures of health plan quality.  Med Care. 2000;38(10):981-99211021671Google ScholarCrossref
Zaslavsky AM, Epstein AM. How patients' sociodemographic characteristics affect comparisons of competing health plans in California on HEDIS quality measures.  Int J Qual Health Care. 2005;17(1):67-7415668313Google ScholarCrossref
Schneider EC, Zaslavsky AM, Epstein AM. Racial disparities in the quality of care for enrollees in Medicare managed care.  JAMA. 2002;287(10):1288-129411886320Google ScholarCrossref
Original Contribution
October 10, 2007

Quality of Care in Medicaid Managed Care and Commercial Health Plans

Author Affiliations

Author Affiliations: Department of Health Care Policy, Harvard Medical School (Drs Landon and Normand); Division of General Medicine and Primary Care, Beth Israel Deaconess Medical Center (Dr Landon); Department of Health Policy and Management (Drs Schneider and Epstein), Department of Biostatistics, Harvard School of Public Health (Dr Normand); and the Section of Health Services and Policy Research, the Division of General Medicine, Brigham and Women's Hospital (Drs Schneider and Epstein), Boston, Massachusetts; National Committee for Quality Assurance, Washington, DC (Drs Scholle and Pawlson).

JAMA. 2007;298(14):1674-1681. doi:10.1001/jama.298.14.1674

Context In contrast to the commercially insured population, the proportion of Medicaid beneficiaries enrolling in health maintenance organizations continues to increase.

Objective To compare quality of care within and between the Medicaid and commercial populations in 3 types of managed care plans: Medicaid-only plans (serving predominantly Medicaid enrollees), commercial-only plans (serving predominantly commercial enrollees), and Medicaid/commercial plans (serving substantial numbers of both types of enrollees).

Design, Setting, and Participants All 383 health plans that reported quality-of-care data to the National Committee for Quality Assurance for 2002 and 2003, including 204 commercial-only plans, 142 Medicaid/commercial plans (plans reported data for the Medicaid and commercial populations separately); and 37 Medicaid-only plans.

Main Outcome Measures Eleven quality indicators from the Healthcare Effectiveness Data and Information Set (HEDIS) applicable to the Medicaid population.

Results Among Medicaid enrollees, performance on the 11 measures observed in this study were comparable for Medicaid-only plans and Medicaid/commercial plans. Similarly, among commercial enrollees, there was virtually no difference in performance between health plans that served only the commercial population and those that also served the Medicaid population. Overall across all health plan types, the performance for the commercial population exceeded the performance for the Medicaid population on all measures except 1, ranging from a difference of 4.9% for controlling hypertension (58.4% for commercial vs 53.5% for Medicaid; P = .002) to 24.5% for rates of appropriate postpartum care (77.2% for commercial vs 52.7% for Medicaid; P = .001). Differences of similar magnitude were observed for commercial and Medicaid populations treated within the same health plan.

Conclusions Medicaid managed care enrollees receive lower-quality care than that received by commercial managed care enrollees. There were no differences in quality of care for the Medicaid population between Medicaid-only plans and commercial plans that also served the Medicaid population.