Quality improvement in Medicaid managed care: Experience of the best clinical and administrative practices initiative.

Background: The Best Clinical and Administrative Practices (BCAP) initiative is part of the Medicaid Managed Care Program (MMCP) operated by the Center for Health Care Strategies. Work groups of 10-12 plans addressed quality of care in designated areas.

Methods And Information Sources: The assessment of BCAP was part of a larger MMCP program evaluation funded by the Robert Wood Johnson Foundation. Case studies were developed for four BCAPs that focused respectively on improving birth outcomes, preventive care for children, asthma care, and care for adults with chronic illnesses or disabilities. They were based on document review and semistructured interviews. Medicaid managed care plans nationwide were also surveyed.

Findings: BCAP participants were overwhelmingly risk-based managed care plans whose enrollment was dominated by Medicaid. Participants said BCAP helped them enhance the way they approach quality improvement. As a result of work group participation, most plans made changes in their delivery of care, and more than half sustained and continued to build on these changes after the work group ended.

Discussion: BCAP participation helped Medicaid plans change the way they think about quality improvement and take sustainable steps to improve quality; the ultimate impact may be stronger once plans become more sophisticated users of such techniques.