PUP 4931r Lecture Notes - Lecture 80: Medicaid Managed Care, Managed Care, Quality Management
16 May 2018
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Medicaid Beneficiaries In California Reported Less Positive Experiences When
Assigned To A Managed Care PlanDiana D. McDonnell and Carrie L. GrahamHealth
Affairs, March 2015 34:3
California began transitioning approximately 340,000 seniors and people with
disabilities from Medicaid fee-for-service (FFS) to Medicaid managed care plans in
2011.
If they did’t hoose a pla, state assiged via algorithm reflecting prior use of
care.
Or if use not significant, randomly assigned by default.
Study reports results of telephone survey of 1,521 seniors and people with
disabilities enrolled in Medi-Cal (California Medicaid)
Found that 48 percent chose their own plan, 11 percent were assigned to a plan
by algorithm, and 41 percent were assigned to a plan by default.
Failure to Choose=Unhappy (Seniors & Disabled)
Those assigned by algorithm or default assignment unhappy
The Evolution Of Quality Management In Medicaid Managed Care Bruce E.
Landon, Eric C. Schneider, Carol Tobias, and Arnold M.Epstein HEALTH A F FA I R S
~ Vo l u m e 2 3 , Nu m b e r 4
Centers for Medicaid and Medicare Services (CMS) has been actively promoting a
quality management agenda for states.
CMS developed the Quality Improvement System for Managed Care (QISMC)
program in 1996 as a guide to quality management oversight for federal and state
health care purchasers.
QISMC is required of health plans participating in Medicare,
voluntary guide for state Medicaid programs.
Quality continued...
Balanced Budget Act (BBA) of 1997 included a comprehensive revision of the
federal statutes governing Medicaid managed care.
specified that Medicaid programs develop and implement a comprehensive
quality assessment and improvement process in both clinical and nonclinical area
and that states conduct an annual external quality review of MMC organizations.
find more resources at oneclass.com
find more resources at oneclass.com
Document Summary
Medicaid beneficiaries in california reported less positive experiences when. Assigned to a managed care plandiana d. mcdonnell and carrie l. grahamhealth. California began transitioning approximately 340,000 seniors and people with disabilities from medicaid fee-for-service (ffs) to medicaid managed care plans in. If they did(cid:374)"t (cid:272)hoose a pla(cid:374), state assig(cid:374)ed via algorithm reflecting prior use of care. Or if use not significant, randomly assigned by default. Study reports results of telephone survey of 1,521 seniors and people with disabilities enrolled in medi-cal (california medicaid) Found that 48 percent chose their own plan, 11 percent were assigned to a plan by algorithm, and 41 percent were assigned to a plan by default. Those assigned by algorithm or default assignment unhappy. The evolution of quality management in medicaid managed care bruce e. Landon, eric c. schneider, carol tobias, and arnold m. epstein health a f fa i r s. ~ vo l u m e 2 3 , nu m b e r 4.
