Access and Quality in Managed Care

Section E of MACPAC’s June 2011 report considers how while managed care programs are intended to emphasize care management, poorly designed or implemented Medicaid managed care systems can create issues for states that may lead to poor enrollee health outcomes. But information on managed care systems can be difficult to obtain. Standards, reporting, and enforcement of managed care contract requirements vary considerably across states, and nationally. The ability to synthesize research across states is constrained since individual studies typically focus on only one or a few states and vary in comprehensiveness, measurement use, and research quality. Existing data and analyses for addressing access are limited and dated, and there are no uniform sets of measures or data sources used by states that could provide comparability of data for assessing access and quality. Read more about the need for evaluation and monitoring of access and quality in Medicaid managed care.