Access and Value: Issues for Medicaid and CHIP as Purchasers

Like all purchasers of health services, Medicaid and the State Children’s Health Insurance Program (CHIP) seek to determine whether the basic requirement of providing sufficient access to necessary, efficient, and effective services is being met, with enrollees receiving appropriate care at the right time in the right setting. Achieving this goal may help improve quality and lower costs, thus achieving better health outcomes and better value. However, complete and timely assessments of enrollees’ access to appropriate care–across the spectrum of services, delivery models, and geographic areas, and for distinct enrollee populations–are needed to assess the impact of service and payment innovations and ultimately judge the success of the programs’ purchasing strategies. Any meaningful effort to assess access in today’s environment, however, also needs to take into account concerns about cost, value, and strengthening program accountability and integrity. Read more about the importance of evaluating access in Medicaid and CHIP as a tool for monitoring and improving program performance.