In this report, Ian Axford Fellow John O’Brien, former director of acute care policy at The Hilltop Institute (as the Center for Health Program Development and Management), compares performance measurement in the New Zealand health care delivery system with performance measurement in HealthChoice, Maryland’s Medicaid managed care program. As illustrated by these two health care delivery systems, performance measurement is likely to be an evolving set of metrics that can be applied for a variety of purposes. Indeed, performance measurement offers a window into the biases and thought processes of policymakers and offers important lessons for health care delivery.
As Medicaid managed care programs mature, states are looking to refine their methods for measuring and improving the performance of participating health plans. This report serves as a guide for Medicaid agencies who want to develop a performance measurement program using administrative data to evaluate the care provided to enrollees with chronic diseases. The report identifies potential performance indicators that are associated with improved medical outcomes and demonstrates the application of diagnosis-based risk adjustment to performance measurement by profiling six health plans.
HealthChoice, Maryland’s Medicaid managed care program, was launched in 1997, with nine managed care organizations participating and 80 percent of the Medicaid population enrolled in the first year. This article, published in The Milbank Quarterly, describes the history of managed care in Maryland, the process for designing and involving stakeholders in the HealthChoice evaluation, and selected evaluation findings.
This manual, prepared by The Hilltop Institute (as the Center for Health Program Development and Management) under contract with the Centers for Medicare and Medicaid Services (CMS), provides a step-by-step approach for state Medicaid programs implementing health-based risk adjustment for managed care organizations. The guide describes information system, financial, and policy issues states should consider, as well as choices related to selecting and implementing a particular methodology. The manual also discusses approaches taken and challenges encountered by other states.
This evaluation of the Maryland HealthChoice program, which began in 1997, assesses the program’s success relative to its original goals and stakeholders’ expectations. The study uses a mix of quantitative data (e.g., encounter data and Maryland Health Services Cost Review Commission data) and qualitative data (e.g., community forums and focus groups) to assess the performance of Maryland’s Medicaid managed care program.
Managed care organizations may be incurring financial losses from persons with HIV/AIDS. Using a statistical model to examine comorbidities that contribute to the variation in health care costs for enrollees with HIV/AIDS, this study developed an improved methodology for calculating capitation payments for this population.
This article, published in the Journal of Ambulatory Care Management, describes the risk-adjusted payment methodology employed by the Maryland Medicaid program to pay managed care organizations. It also presents an empirical simulation analysis using claims data from 230,000 Maryland Medicaid recipients.