AHIP study: How Medicaid managed care plans have made gains in quality improvement 

Medicaid on paper and a stethoscope
AHIP has released its second study examining Medicaid managed care plans. (Getty/designer491)

Medicaid managed care plans saw a significant boost in quality between 2014 and 2018, a new study shows. 

Researchers at The Menges Group analyzed quality improvement in managed care on behalf of America’s Health Insurance Plans (AHIP), and found that over those five years managed care organizations improved performance across 87% of Healthcare Effectiveness Data Information Set (HEDIS) and Consumer Assessment of Healthcare Providers and Systems (CAHPS) measures. 

The 30 measures studied include how members rate their health plan, control of diabetic members’ HbA1c levels, medication adherence for asthma patients and blood pressure management. 

“Medicaid managed care plans are making good on the commitment to provide their members with high-quality coverage and healthcare,” said Matt Eyles, AHIP’s CEO, in a statement. “The data are clear that continuous quality improvement is a hallmark of Medicaid managed care.” 

RELATED: AHIP study—Managed care saves billions on drugs compared to traditional Medicaid 

The study is the second in a series backed by AHIP examining Medicaid managed care that the group plans to release over the course of 2020. The first study found that managed care organizations saved $6.8 billion on prescription drugs in 2018. 

Medicaid managed care members are increasingly enrolled in plans that are accredited by the National Committee for Quality Assurance, the study found, with 77.2% of members in such a plan in 2018. That’s up from 71.4% in 2015. 

The number of states that use quality incentive programs is also growing, according to the study. For example, 23 states and the District of Columbia offer bonus payments to managed care plans that meet certain quality targets. 

Twenty-four states and the District of Columbia use a capitation withhold, with a payback contingent on quality performance. Plus, eight states preferentially auto-assign members to high-quality plans. 

“By working together with the public sector, Medicaid managed care plans are delivering to Medicaid enrollees the high-quality care and coverage they deserve, leading to better outcomes and improved quality of life,” the study says. 

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