Improving the quality and cost-effectiveness of publicly financed health care
Business Case for Quality in Medicaid Managed Care
With Medicaid costs escalating on state budgets, the broad system-wide financial, economic, and social benefits of improving the quality of Medicaid services must be documented in order for health care quality to be a priority for states, health plans, and the federal government. CHCS partnered with researchers at the University of North Carolina School of Public Health to undertake the Business Case for Quality in Medicaid Managed Care (BCQ). This demonstration project with 10 Medicaid managed care entities assessed the return on investment for efforts to improve the quality of publicly financed health care.
The purposes of BCQ was to:
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Determine whether or not “quality pays,” by testing the costs and benefits of evidence-based quality improvement efforts.
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Identify where health care payment systems need to be realigned to support quality improvement.
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Promote further investments by all stakeholders — the federal government, states, health plans, providers, and consumers — in quality improvement efforts in Medicaid managed care.
Ten demonstration projects, which ran from June 2004 through December 2006, included eight fully-capitated Medicaid managed care organizations, one state Primary Care Case Management program, and one External Quality Review Organization. Among the projects, a mix of evidence-based initiatives on asthma, diabetes, and prenatal care were juxtaposed with projects devoted to addressing the needs of populations with multiple chronic illnesses, including coordinated services for adults with complex needs and long-term care services for dual eligible recipients.
Participating organizations included:
- AXIS Healthcare
- Arkansas Department of Human Services/Division of Medical Serivces
- CareOregon
- Community Living Alliance/Wisconsin Partnership Program
- Johns Hopkins University
- Mercy Care Plan
- Monroe Plan for Medical Care
- Partnership Health Plan
- Sentara Health Management
- Wisconsin Department of Health and Family Services