Kaiser Family Foundation Survey on State Medicaid Managed Care ...

program does not require health plans to be accredited or reward them for this status. For example,of the 25 highest-ranked Medicaid plans in 2010-2011, seven are in Delaware, New York, orPennsylvania, states that do not mandate accreditation.• PCCM performance measurement. Eighteen of the 31 states operating a PCCM program indicatedthat they used HEDIS© measures to assess access and quality performance (Table 11); all but threeof these states also use state-specific measures similar to those used for MCOs. The 18 statesinclude nine states where PCCM is the only form of comprehensive Medicaid managed care, andnine states that operate both PCCM and MCO programs. In assessing the quality of a PCCMprogram, the stateessentially treats theprogram as a health planwith an enrolled population.States typically use fewerperformance measuresfor PCCM programs than forMCOs. The median numberof required measures is 16,but again, considerablevariation occurs acrossstates, with four statesrequiring seven or fewermeasures (Georgia,Louisiana, Massachusetts,and North Carolina), whilefive states use at least 25measures (Kansas, Maine,Pennsylvania, SouthCarolina, and Texas);Pennsylvania indicated thatit uses the entire HEDIS©data set. Required measuresin PCCM programs tend tofocus on access, rating ofprovider, preventive care,and management of chronicdiseases.Seventeen states reportedconducting CAHPS© surveysto assess patient experiencewithin PCCM programs. Thesurveys are conductedannually in seven states, andevery second or third year inthe others. Some statesalternate the child and adultTable 11: HEDIS© Measures Used for PCCM Programs, FY 2011(18 states responding)HEDIS© measureNo. of statesrequiring measurein 2011How Well Doctors Communicate 13Getting Needed Care 13Use of Appropriate Medications for People WithAsthma 13Rating of Personal Doctor 12Rating of All Health Care 12Getting Care Quickly 12Breast Cancer Screening 12Cervical Cancer Screening 12Rating of Specialist Seen Most Often 11Childhood Immunization Status 11Comprehensive Diabetes Care 11Customer Service 11Prenatal and Postpartum Care 11Rating of Health Plan 10Comprehensive Diabetes Care - HbA1c PoorlyControlled 8Chlamydia Screening in Women 7Medical Assistance With Smoking Cessation 6Cholesterol Management for Patients WithCardiovascular Conditions 6Follow-Up for Children Prescribed ADHD Medication 5Appropriate Testing for Children With Pharyngitis 5Controlling High Blood Pressure 5Use of Spirometry Testing in the Assessment andDiagnosis of COPD 4Antidepressant Medication Management 4Appropriate Treatment for Children With UpperRespiratory Infection 4Avoidance of Antibiotic Treatment in Adults WithAcute Bronchitis 4Use of Imaging Studies for Low Back Pain 3Follow-Up After Hospitalization for Mental Illness 336 00