Many children in Medicaid managed care do not receive same quality of care

September 16, 2003

New York City, September 16, 2003--Children enrolled in Medicaid managed care plans had lower rates than those in commercial plans for quality indicators such as immunization rates and well-child visits, according to a study in the September 17th issue of the Journal of the American Medical Association (JAMA), conducted with support from The Commonwealth Fund.

The findings of the study, "Quality of Care for Children in Commercial and Medicaid Managed Care," by Joseph W. Thompson, M.D., of the Department of Pediatrics at the University of Arkansas for Medical Sciences and colleagues, indicate the need to understand the factors that would improve quality of care for all health plan enrollees, and particularly for those who are Medicaid enrollees.

The study compared standard indicators of clinical performance measures through the Health Plan Employer Data and Information Set (HEDIS) in 423 commercial and 169 Medicaid plans. Across all plans, the mean plan performance for commercial enrollees on childhood immunizations was 64% of 2-year-olds completely immunized, whereas for plans with Medicaid enrollees the mean performance was 49%. For HEDIS measures for well-child visits for children in the first 15 months of life, the mean plan performance was 50% for commercial enrollees, compared with 27% for Medicaid enrollees. In the 81 plans serving both populations, similar differences were noted, with Medicaid enrollees having significantly lower rates for clinical quality indicators than commercial enrollees for immunization rates (69% vs. 54%) and well-child visits (53% vs. 31%).

The study also revealed that some of the plans with both commercial and Medicaid enrollees were able to achieve high HEDIS performance measures of 75% and over for both groups. "It is important to understand exactly how these plans are able to provide better care to all their enrollees," said Stephen C. Schoenbaum, M.D., senior vice president of The Commonwealth Fund. "These plans are potential role models and may provide important lessons for other commercial and Medicaid plans."
The Commonwealth Fund is a private foundation supporting independent research on health and social issues.

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