New White Paper Series Looks at the Current State of Quality
Measurement and Important Considerations for the Development of Quality
WASHINGTON--(BUSINESS WIRE)--Nov. 17, 2016--
Quality measurement and reporting in Medicaid managed care programs have
gained heightened attention as states enroll more Medicaid
beneficiaries, including more diverse populations, into managed care
plans. As states expand the role of managed care organizations (MCOs),
quality measurement is a key part of assessing the impact on enrollees
and their health outcomes, according to a new series of white papers
from Anthem’s Public Policy Institute.
To date, states have had tremendous flexibility to design their quality
measurement systems, including selecting metrics and setting benchmarks
for MCOs’ performance that align with states’ priorities. Some states
have then incorporated the results into quality rating systems designed
to help consumers compare MCOs and consider quality when selecting a
New federal regulations released by the Centers for Medicare & Medicaid
Services (CMS) in April 2016 establish greater consistency, requiring
all states to develop a quality rating system that draws from a core set
of measures and common methodology. One of the three papers from the
Anthem Public Policy Institute examines the impact that quality rating
systems have on individuals, health plans, and providers.
“Surprisingly, we found that, currently, there is little evidence one
way or the other on the impact of Medicaid rating systems on plan
choice,” said Jennifer Kowalski, vice president of the Anthem Public
Policy Institute. “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.”
three papers highlight several areas for consideration on the future
of quality rating systems:
Quality measures should be well-tested, evidence-based, peer-reviewed,
and focused on measuring the health outcomes of individuals.
Particular attention should be given to ensuring metrics are
representative of the growing diversity of managed care enrollees and
their health care needs, such as behavioral health and long-term
services and supports.
As CMS considers a nationwide quality rating framework, it should
build on the successful models already underway in many states. States
should continue to serve as testing grounds for innovative quality
measurement and reporting approaches.
It will be critical to assess on an ongoing basis whether and to what
extent quality rating systems are able to effectively drive changes in
consumer, health plan and provider behavior. Additional work should
focus on ensuring that consumer-facing quality ratings are clear,
relevant, and align with consumers’ other priorities related to health
The three paper series from the Anthem Public Policy Institute discusses
these issues in greater detail:
Copies of the Anthem Public Policy Institute’s white papers are
available at: http://anthempublicpolicyinstitute.com,
and are also discussed at: http://thinkanthem.com.
About the Anthem Public Policy Institute
The Anthem Public Policy Institute was established to share data and
insights to inform public policy and shape the health care programs of
the future. The Public Policy Institute strives to be an objective and
credible contributor to health care innovation and transformation
through publication of policy-relevant data analysis, timely research
and insights from Anthem’s innovative programs.
About Anthem, Inc.
Anthem is working to transform health care with trusted and caring
solutions. Our health plan companies deliver quality products and
services that give their members access to the care they need. With over
72 million people served by its affiliated companies, including more
than 39 million enrolled in its family of health plans, Anthem is one of
the nation’s leading health benefits companies. For more information
about Anthem’s family of companies, please visit www.antheminc.com/companies.
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Source: Anthem, Inc.
Joyzelle Davis, (303) 831-2005