Outcomes measurement and management with a large Medicaid population: a public/private collaboration

Recipients, consumer advocates and purchasers expect managed care companies, in partnership with their provider networks, to measure and to continuously improve quality of care. This task is especially challenging when the beneficiaries of that care are covered by a publicly funded program. Yet this will be an increasingly common occurrence as more states contract with managed care companies for the care management of their Medicaid populations. In this article, the authors describe the outcomes measurement and management program of the first statewide managed Medicaid behavioral health carve-out program. Much of the foundation of that program has been built through collaborative efforts between the Massachusetts Division of Medical Assistance as purchaser, MHMA as managed care vendor, recipients, providers and other stakeholders. The authors report on the FMH/MHMA experience and what they learned. The principles derived from this outcomes program may be helpful to other states and to managed care companies undertaking similar public/private partnerships.