Anthem group outlines quality reporting reforms for Medicaid managed care


The Medicaid managed care market, which has evolved to account for $240 billion of the $525 billion spent annually on Medicaid, is still in need of better quality measurement and reporting, according to Anthem's Public Policy Institute. 

Three new white papers from the institute outline a slew of new considerations for transforming quality measurement and reporting in Medicaid managed care arrangements. 

There is astoundingly little evidence that Medicaid rating systems currently impact members’ choice of plans, Jennifer Kowalski, a top official at the institute, noted in an announcement. However, “the changes expected for Medicaid quality ratings underscore the need for greater study of what measures and strategies are most effective in engaging consumers to consider quality when selecting a plan,” she said.

Ideally, quality measures will be well-tested, empirically supported, peer-reviewed, and perhaps most importantly, describe individual outcomes in a way that’s meaningful and understandable, the announcement adds. 

RELATED: Feds finalize sweeping Medicaid managed care rule

Here is a brief summary of the three white papers' findings:

  • Private health plans, state and federal government entities, and employers all want to ensure the health services they are paying for are high-value and improve individuals’ health, but as it stands now, “the lack of available, reliable data other than claims presents another challenge for Medicaid agencies and for quality measurement generally, particularly for assessing health outcomes,” the first white paper (PDF) notes.
  • The current system allows for considerable flexibility for states to determine quality measures, according to the second white paper (PDF). Many states tailor their measures to specific priorities, but many of the measures used by states are not nationally recognized.
  • In light of the current fragmented system, the second white paper suggests that higher levels of consistency in Medicaid managed care quality measures “would facilitate national benchmarking and potentially support a federal quality improvement agenda."
  • Anthem notes in the third white paper (PDF) that only “small number of states” have developed systems for quality rating, as opposed to only quality measurement. The institute recommends that states use Medicaid managed care organizations' quality ratings to inform development of their quality improvement goals and objectives and direct their oversight of health plans.
  • Reporting standards can be improved by paying more attention to the diversifying demographics of Medicaid and the services these populations require, such as behavioral healthcare and long-term services, the first white paper notes. While the Centers for Medicare & Medicaid Services contemplates a national framework, the institute notes in the second white paper that states should remain testing grounds for innovation and that a national framework could emerge from successful models already adopted by states. 

In the wake of the election, the Medicaid program faces significant uncertainty given Republicans' plans to convert funding to block grants. This means that firms with significant Medicaid managed care exposure could see their share prices take a hit, specifically Anthem, Centene and Molina, Leerink Partners analyst Ana Gupte has said.