Strategies for Assessing Health Plan Performance on Chronic Diseases
As Medicaid managed care programs mature, states are looking to refine their methods of measuring and improving the performance of participating health plans. This CHCS Resource Paper serves a guide for Medicaid agencies who want to develop a performance measurement program using administrative data to evaluate the care provided to enrollees with chronic diseases.
It reviews the factors to consider when developing a program and identifies potential performance indicators that are associated with improved medical outcomes. Using encounter data from Maryland's Medicaid program, the report also demonstrates the application of diagnosis-based risk adjustment to performance measurement by profiling six health plans.
Appendices provide details regarding performance measures, plan performance, demographic data, and risk adjustment.