Emerging Practices in Medicaid Primary Care Case Management Programs. Quality Activities

06/01/2001

States are increasingly monitoring quality of care in PCCM programs using multiple strategies. As evidenced in Charts F and G, the strategies with the greatest increased use by states include: spot-checking 24-hour availability of PCPs (from 11 states or 58 percent of the 19 states with PCCM programs in 1990 to 25 states or 86 percent of the 29 states with programs in 1998); member survey/focus groups (from 13 states or 68 percent in 1990 to 25 states or 86 percent in 1998); member hotlines (from nine states or 47 percent in 1990 to 24 states or 83 percent in 1998); and random medical record review (from 13 states or 68 percent in 1990 to 24 states or 83 percent in 1998). Other methods include focused studies, PCCM provider performance feedback, monitoring voluntary disenrollments of members, provider hotlines, disenrollment surveys, on-site state reviews/audits, desk reviews/audits, and ombudsman programs.

Chart F:

Selected Monitoring Activities in PCCM Programs. See text for explanation of chart.

Chart G:

Selected Member Services Activities in PCCM Programs. See text for explanation of chart.

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