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How far have state Medicaid agencies advanced in performance measurement for children?
M A McManus1, R R Graham, H B Fox
1Maternal & Child Health Policy Research Center, Washington, DC 20006-4607, USA. mcmanus@wizard.net
Insights
State Medicaid agencies in 1998 focused on pediatric preventive care, particularly immunizations, but neglected acute illness treatment. Quality oversight for children
Area of Science:
- Pediatric Health Services Research
- Health Policy and Management
- Quality Improvement in Healthcare
Background:
- Children constitute the largest demographic in Medicaid managed care.
- Limited understanding exists regarding pediatric performance measures utilized by state Medicaid agencies.
Purpose of the Study:
- To ascertain Medicaid managed care requirements for the Health Plan Employer Data and Information Set (HEDIS) and other performance measures for children (0-21 years).
Main Methods:
- A structured telephone survey was conducted to assess pediatric performance measures.
- Survey participants included state Medicaid officials overseeing managed care quality in 39 states.
Main Results:
- In 1998, state Medicaid agencies prioritized monitoring pediatric preventive care, with immunization rates as the main focus.
- Assessment of acute illness treatment received less attention.
- Over half of states monitored chronic childhood conditions, primarily asthma and specific mental health diagnoses.
Conclusions:
- States are in early stages of developing quality oversight systems for Medicaid-enrolled children.
- Enhanced quality reporting is necessary to evaluate the treatment of acute and chronic illnesses in children, requiring more age-specific metrics.
Background:
While children represent the largest population group enrolled in Medicaid managed care, little is known about the pediatric performance measures used by state Medicaid agencies.
Objective:
To identify Medicaid managed care requirements for using Health Plan Employer Data and Information Set and other performance measures for children (defined as those aged 0-21 years in this study).
Design:
A structured telephone survey of pediatric performance measures.
Participants:
Survey respondents were state Medicaid officials responsible for managed care quality oversight in 39 states.
Main Outcome Measures:
Percentage of states in 1998 with effectiveness-of-care measures on health promotion and disease prevention, early detection and screening, and acute and chronic illness; with use measures on preventive care, ambulatory care, pharmacy, inpatient hospital care, and mental health and chemical dependency services; and with access measures on primary care, low-birth-weight neonates delivered at appropriate facilities, and dental care.
Results:
In 1998, state Medicaid agencies placed most of their emphasis on monitoring preventive care for children, with immunization rates being the primary focus. Far less attention was directed at assessing the treatment of acute illness. Although more than half of states monitored the treatment of chronic childhood conditions, they focused exclusively on asthma and selected mental health diagnoses.
Conclusions:
States are still in the initial phases of designing and implementing quality oversight systems for Medicaid-insured children. Additional quality reporting requirements are clearly needed to assess the treatment of acute and chronic illness among children along with more age-specific reporting requirements.