WASHINGTON--(BUSINESS WIRE)--Quality measurement and reporting in Medicaid managed care programs have gained heightened attention as states enroll more Medicaid beneficiaries, including more diverse populations, into managed care plans. As states expand the role of managed care organizations (MCOs), quality measurement is a key part of assessing the impact on enrollees and their health outcomes, according to a new series of white papers from Anthem’s Public Policy Institute.
To date, states have had tremendous flexibility to design their quality measurement systems, including selecting metrics and setting benchmarks for MCOs’ performance that align with states’ priorities. Some states have then incorporated the results into quality rating systems designed to help consumers compare MCOs and consider quality when selecting a plan.
New federal regulations released by the Centers for Medicare & Medicaid Services (CMS) in April 2016 establish greater consistency, requiring all states to develop a quality rating system that draws from a core set of measures and common methodology. One of the three papers from the Anthem Public Policy Institute examines the impact that quality rating systems have on individuals, health plans, and providers.
“Surprisingly, we found that, currently, there is little evidence one way or the other on the impact of Medicaid rating systems on plan choice,” said Jennifer Kowalski, vice president of the Anthem Public Policy Institute. “The changes expected for Medicaid quality ratings underscore the need for greater study of what measures and strategies are most effective in engaging consumers to consider quality when selecting a plan.”
The three papers highlight several areas for consideration on the future of quality rating systems:
- Quality measures should be well-tested, evidence-based, peer-reviewed, and focused on measuring the health outcomes of individuals. Particular attention should be given to ensuring metrics are representative of the growing diversity of managed care enrollees and their health care needs, such as behavioral health and long-term services and supports.
- As CMS considers a nationwide quality rating framework, it should build on the successful models already underway in many states. States should continue to serve as testing grounds for innovative quality measurement and reporting approaches.
- It will be critical to assess on an ongoing basis whether and to what extent quality rating systems are able to effectively drive changes in consumer, health plan and provider behavior. Additional work should focus on ensuring that consumer-facing quality ratings are clear, relevant, and align with consumers’ other priorities related to health plan selection.
The three paper series from the Anthem Public Policy Institute discusses these issues in greater detail:
- The “Nuts and Bolts” Behind Quality Measurement in Medicaid Managed Care. This first paper explores the state of quality measurement in state Medicaid programs and makes several recommendations to improve quality measures.
- Balancing Standardization and State Flexibility in Medicaid Quality Measurement and Reporting. This paper analyzes the variation in current state approaches to quality measurement for Medicaid MCOs and discusses the trade-offs between standardization of measures and state flexibility to innovate and use state-specific measures.
- The Impact of Medicaid Quality Rating Systems on Consumer, Health Plan and Provider Behavior. The final paper examines state-developed quality rating systems that help consumers compare quality among health plans, with the goal of encouraging them to consider health plan quality when selecting a plan.
About the Anthem Public Policy Institute
The Anthem Public Policy Institute was established to share data and insights to inform public policy and shape the health care programs of the future. The Public Policy Institute strives to be an objective and credible contributor to health care innovation and transformation through publication of policy-relevant data analysis, timely research and insights from Anthem’s innovative programs.
About Anthem, Inc.
Anthem is working to transform health care with trusted and caring solutions. Our health plan companies deliver quality products and services that give their members access to the care they need. With over 72 million people served by its affiliated companies, including more than 39 million enrolled in its family of health plans, Anthem is one of the nation’s leading health benefits companies. For more information about Anthem’s family of companies, please visit www.antheminc.com/companies.