Medicaid and CHIP Risk-Based Managed Care in 20 States. Experiences Over the Past Decade and Lessons for the Future.. Quality Monitoring


Concerns that risk-based managed care could harm beneficiaries (through incentives to reduce care or provide substandard care) have gradually led to more intensive monitoring of quality of care for Medicaid and CHIP managed care programs. The federal government and states have adopted a broad definition of quality to include utilization of appropriate services, outcomes, and beneficiary satisfaction. A major advantage of the managed care delivery system is that it facilitates the measurement of health care quality, through improved information systems and a population-based approach to quality measurement.

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