System change: quality assessment and improvement for Medicaid managed care.
Smith, Wally R
Date of Pub
Cotter, James J; Rossiter, Louis F
Rising Medicaid health expenditures have hastened the development of State managed care programs. Methods to monitor and improve
health care under Medicaid are changing. Under fee-for-service (FFS), the primary concern was to avoid overutilization. Under
managed care, it is to avoid underutilization. Quality enhancement thus moves from addressing inefficiency to addressing insufficiency
of care. This article presents a case study of Virginia's redesign of Quality Assessment and Improvement (QA/I) for Medicaid,
adapting the guidelines of the Quality Assurance Reform Initiative (QARI) of the Health Care Financing Administration (HCFA).
The article concludes that redesigns should emphasize Continuous Quality Improvement (CQI) by all providers and of multi-faceted,
Guidelines : Health Services Accessibility : Health Services Research : Health Status Indicators : Managed Care Programs/organization
& administration/standards/utilization : Medicaid/organization & administration/standards/utilization : Medical Audit : Patient
Satisfaction : Quality Assurance, Health Care/organization & administration : Reimbursement Mechanisms : State Health Plans/organization
& administration/standards/utilization : Support, Non-U.S. Gov't : United States : Virginia