Quality improving among Medicaid managed care plans: 3 study findings

Medicaid managed care plans — which serve two-thirds of all Medicaid enrollees — have consistently improved performance on more than 25 quality metrics since 2014, according to a report from America's Health Insurance Plans.

The Menges Group, a healthcare consulting firm, conducted the research on behalf of AHIP. Researchers analyzed Medicaid managed care plan performance for 30 Healthcare Effectiveness Data and Information Set and CAHPS quality measures between 2014 and 2018. Data sources included the Kaiser Family Foundation and the National Committee for Quality Assurance's Medicaid Quality Compass database.

Three report takeaways:

1. Medicaid managed care plans improved performance on 26 of the 30 HEDIS and CAHPS measures between 2014 and 2018. The four measures that did not see improvement were:

  • Childhood immunization status
  • Asthma medication ratio
  • Prenatal and postpartum care
  • Use of imaging studies for low back pain

2. In 2018, 77.2 percent of Medicaid managed care enrollees were NCQA-accredited health plans, compared to just 71.4 percent in 2015.

3. Twenty-four states withhold a small portion of capitation payments to incentivize Medicaid managed care plans to meet or exceed quality metrics. Twenty-three states also offer bonus payments based on quality performance.

To view the full report, click here.


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