Policy changes to the Medicaid program are directing the quality of care for beneficiaries. This multifacted analysis used data from one state from the Health Care Financing Administration's State Medicaid Research Files to assess the quality of primary and preventive care utilized by Medicaid beneficiaries. Patients were assigned to one of nine categories of care where they received the majority of ambulatory care. These nine provider types were evaluated using a series of three sets of claims-based performance measures, adjusting for patient case-mix, including preventive care and hospitalizations for certain conditions. The results from this analysis showed that patients with a regular source of care had fewer admissions for certain conditions and used more preventive care services. Additionally, case-mix adjustment significantly improved the performance of providers. These findings suggest many ambulatory care providers are not equally effective in managing the health needs of their patients. This analysis indicates that available state claims data should be used to assess the performance of Medicaid providers in improving the health of beneficiaries.
Learning Objectives: During this session, faculty will discuss recent analysis regarding the utilization and quality of care among different sources of ambulatory health care
Keywords: Quality Improvement, Medicare/Medicaid
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: Employment