Monitoring clinical quality in Medicaid managed care

With the recent exponential growth in managed-care plan enrollment by Medicaid beneficiaries, a variety of quality monitoring systems have emerged. This paper argues that existing quality monitoring systems, originally designed for use by employers in the private sector, are a useful starting point for quality monitoring in the Medicaid program, but that substantial enhancements are needed to provide adequate quality assurance for Medicaid beneficiaries. This paper describes the development of a range of indicators for monitoring the clinical aspect of the quality of care for Medicaid beneficiaries and offers a framework for adapting existing monitoring systems to the needs of the Medicaid population. This work is part of a larger collaborative effort by the Connecticut Department of Public Health and the Department of Epidemiology and Public Health of Yale University School of Medicine to develop a blueprint for state government's role in quality assessment and performance management for managed care.