New Study: Quality Performance Is Up Across The Board For Medicaid Managed Care Plans

posted by Kristine Grow

on March 3, 2020

Analysis by The Menges Group finds that Medicaid managed care plans improved their performance in 26 of 30 key quality metrics
between 2014 and 2018

WASHINGTON, D.C. –  Americans with Medicaid deserve high-quality coverage and care. As part of their commitment to serving Medicaid enrollees and ensuring their access to high-quality care, Medicaid managed care plans have continued to consistently improve their performance across a range of quality measures over a 5-year period. That’s according to new research from The Menges Group, conducted on behalf of America’s Health Insurance Plans (AHIP).

The major takeaways from today’s study include:

  • Medicaid managed care plans improved their performance on 26 out of 30 (87%) key HEDIS® and CAHPS® quality measures* between 2014 and 2018. The improvements covered a broad range of measures–from providing comprehensive diabetes care to controlling high blood pressure.
  • 77% of Medicaid managed care enrollees in 2018 were members of NCQA-accredited health plans, up from 71% in 2015. Accreditation by the NCQA signifies a high level of quality.
  • 24 states recognize the value of ongoing quality improvement in their managed care programs by incentivizing Medicaid managed care plans to meet or exceed quality targets. The number indicates the value states place on Medicaid managed care plans and the quality they provide.

Today’s announcement marks the second of a series of studies on the performance of Medicaid managed care plans conducted by The Menges Group for AHIP. Additional studies to be released in 2020 examine other key aspects of performance, including the use of innovative programs and technology, and the value Medicaid managed care plans provide to states.

Improving Quality for Medicaid Enrollees

One in five Americans are covered by Medicaid, including millions of children, older adults, people with disabilities, and 2 million veterans. Two-thirds of Medicaid enrollees – more than 56 million people – are served by Medicaid managed care plans.

Medicaid managed care plans are improving access and the overall quality of care for Medicaid enrollees as states increasingly rely on them to provide quality management programs that improve health outcomes.

Through a combination of ongoing work by dedicated and experienced staff, close relationships with doctors and other providers, and significant investments to track quality performance, Medicaid managed care plans are improving the quality of care in Medicaid across the board.

Medicaid managed care plans are responsible stewards of taxpayer dollars. They perform a significant range of network management, care management, and operational functions for states while controlling Medicaid program costs and delivering high quality coverage, demonstrating how efficiently and effectively they serve Medicaid enrollees and hardworking taxpayers.

“Medicaid managed care plans are making good on the commitment to provide their members with high-quality coverage and health care,” said Matt Eyles, AHIP President and CEO. “The data are clear that continuous quality improvement is a hallmark of Medicaid managed care. Medicaid managed care plans are delivering the high-quality coverage and care their members deserve.”

From quality performance to innovation to prescription drug delivery, Medicaid managed care is focused on putting people with Medicaid first and delivering the quality and value they deserve.

Read the full study.

* Note: The National Committee for Quality Assurance (NCQA) is an independent organization that studies how well health plans and doctors provide scientifically recommended care. NCQA administers a number of major healthcare quality measurement programs, including HEDIS (Healthcare Effectiveness Data and Information Set) and the CAHPS (Consumer Assessment of Healthcare Providers and Systems) survey.