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www.ahrq.gov/topics/managed-care.html
Topic: Managed Care
The Medical Expenditure Panel Survey tracks costs of health insurance, including … managed care plans.
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www.ahrq.gov/research/findings/factsheets/managed/mcotoolria/
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www.ahrq.gov/sites/default/files/wysiwyg/cahps/cahps-database/health-plan-5.1-child-composite-measures.pdf
January 24, 2024 - Rates include managed care population (1 MCO). … Rates include managed care population (1 MCO). … Rates include managed care population. … Rates include managed care population. … Rates include managed care population.
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www.ahrq.gov/sites/default/files/wysiwyg/cahps/cahps-database/health-plan-5.1-adult-composite-measures.pdf
January 24, 2024 - Rates include managed care population (2 MCOs). … Rates include managed care population (1 MCO). … Rates include managed care population (1 MCO). … Rates include managed care population. … Rates include managed care population (1 MCO).
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www.ahrq.gov/patient-safety/quality-resources/tools/chtoolbx/uses/fbba97.html
December 01, 2017 - relating to performance measurement and quality, as described below:
Subtitle H: Medicaid - Chapter 1: Managed … requirements in Sec. 4704 and 4705:
Sec. 4704 requires "annual external independent review of [Medicaid] managed … Sec. 4705 requires "any State contracting with Medicaid managed care organizations to develop and implement … of individuals with special health care needs and chronic conditions who are enrolled with Medicaid managed
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www.ahrq.gov/sites/default/files/wysiwyg/data/SyH-DR-Person-Level-Variables-2024.pdf
January 01, 2024 - Care
Organization (MCO)
Enrollment - January MDCD_MCO_ENRLMT_1 X NUM 3
Medicaid Managed Care … - April MDCD_MCO_ENRLMT_4 X NUM 3
Medicaid Managed Care
Organization (MCO)
Enrollment - May … _6 X NUM 3
Medicaid Managed Care
Organization (MCO)
Enrollment - July MDCD_MCO_ENRLMT_7 X NUM … Managed Care
Organization (MCO)
Enrollment - September MDCD_MCO_ENRLMT_9 X NUM 3
Medicaid Managed … Care
Organization (MCO)
Enrollment - October MDCD_MCO_ENRLMT_10 X NUM 3
Medicaid Managed Care
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www.ahrq.gov/ncepcr/tools/cultural-competence/oralling.html
July 01, 2019 - Culturally and linguistically diverse group members currently comprise 50 percent of managed Medicaid … groups, since they represent such a rapidly increasing share of the managed care market. … care utilization and are important to managed care accreditation performance (e.g., HEDIS). … Step 2: Assess the Capabilities of the Managed Care Plan. … Step 3: Identify Points of Contact for Members of Managed Care Plans.
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www.ahrq.gov/sites/default/files/wysiwyg/pqmp/measures/duration/chipra-153-section-8a.pdf
January 01, 2011 - Additionally, while some
states usually provide managed care claims, others do not (Byrd and Verdier … Testing managed care claims data quality in each state
Managed care claims data is sometimes absent … from MAX, and what managed care data is
reported is not always validated before inclusion. … In order to address this problem, we review the
managed care (MC) data reporting relative to fee for … This provides a check on the completeness of managed care data in each state.
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www.ahrq.gov/ncepcr/tools/cultural-competence/planclas.html
July 01, 2019 - Planning Culturally and Linguistically Appropriate Services
Guide for Managed Care Plans
To … The Business Case for CLAS in Managed Care
There is a plausible business case for plans to initiate … diverse groups, since they represent such a rapidly increasing share of the managed care market. … care utilization and are important to managed care accreditation performance (e.g., HEDIS). … Assessing the Managed Care Plan.
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www.ahrq.gov/sites/default/files/wysiwyg/cahps/news-and-events/events/20140115_DB/3_Deborah_Kilstein_slides_29-40.pdf
January 15, 2014 - ACAP’s 58 Plans are in 25 States
31
Medicaid Managed Care and Traditional Enrollment
1999 - 2011 … 2008 2009 2010 2011
Number Enrolled in Traditional Medicaid Programs
Number Enrolled in Medicaid Managed … 45.7 46.0
47.1
50.5
54.6
57.1
Source: Centers for Medicare & Medicaid Services, 2011 Medicaid Managed … Care Enrollment Report. 32
32
Medicaid Managed Care is No
Longer Just Moms and Kids
24 ACAP … Care and Traditional Enrollment 1999 - 2011
Medicaid Managed Care is No Longer Just Moms and Kids
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www.ahrq.gov/cahps/surveys-guidance/mental-health/index.html
March 01, 2025 - The ECHO Survey has separate versions for Managed Care Organizations (MCOs) and Managed Behavioral Health … Users of the ECHO Survey have included State Medicaid agencies, State mental health agencies, managed … behavioral health organizations (MBHOs), and managed care organizations (MCOs). … care organization or managed behavioral healthcare organization. … Download the Managed Care Organization (MCO) Survey and Instructions (ZIP, 4 MB) The MCO Survey asks
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www.ahrq.gov/patient-safety/quality-resources/tools/chtoolbx/measures/measure-8.html
December 01, 2017 - Return to Contents
Minnesota
HEDIS® 2003 Medicaid Managed Care Results
The Minnesota Department … of Human Services produced a report, HEDIS® 2003 Medicaid Managed Care Results , showing multiple HMO … For the home page of the New York managed care office, go to: https://www.health.ny.gov/health_care/ … Comparisons of HEDIS Results by Systems of Care
The North Carolina Division of Medical Assistance Managed … Return to Contents
Ohio
Medicaid Managed Care Customer Satisfaction Survey
Ohio's Health Plans,
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www.ahrq.gov/news/newsroom/case-studies/coe0501.html
October 01, 2014 - Performance Measures
Search All Impact Case Studies
August 2004
Wisconsin's state Medicaid managed … development of the state's MEDDIC-MS (Medicaid Encounter Data Driven Improvement Core Measure Set) managed … "In my opinion, state Medicaid programs that use managed care as a delivery system nationwide will find … measurement, I can think of no other single resource on the subject of higher value to state Medicaid managed … "As other Medicaid managed care programs are developed for special populations here in Wisconsin, the
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www.ahrq.gov/sites/default/files/wysiwyg/data/SyH-DR-Data-Dictionary-Person-Level-Variables-2024mar.csv
April 01, 2024 - No No No
Medicaid Managed Care Organization (MCO) Enrollment - January MDCD_MCO_ENRLMT_1 X NUM 3 … No No No
Medicaid Managed Care Organization (MCO) Enrollment - October MDCD_MCO_ENRLMT_10 X NUM 3 … No No No
Medicaid Managed Care Organization (MCO) Enrollment - November MDCD_MCO_ENRLMT_11 X NUM … No No No
Medicaid Managed Care Organization (MCO) Enrollment - December MDCD_MCO_ENRLMT_12 X NUM … No No No
Medicaid Managed Care Organization (MCO) Enrollment - February MDCD_MCO_ENRLMT_2 X NUM 3
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www.ahrq.gov/professionals/quality-patient-safety/quality-resources/tools/chtoolbx/fbba97.html
December 01, 2017 - relating to performance measurement and quality, as described below:
Subtitle H: Medicaid - Chapter 1: Managed … requirements in Sec. 4704 and 4705:
Sec. 4704 requires "annual external independent review of [Medicaid] managed … Sec. 4705 requires "any State contracting with Medicaid managed care organizations to develop and implement … of individuals with special health care needs and chronic conditions who are enrolled with Medicaid managed
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www.ahrq.gov/patient-safety/settings/long-term-care/resource/hcbs/findings/tab3b.html
December 01, 2012 - 4.74
7.67
7.51
8.71
7.62
HMO (%)
2.49
0.10
1.26
1.18
1.47
2.41
1.81
Managed … %)
2.40
3.98
4.11
1.86
4.06
2.12
3.02
HMO (%)
s
s
s
s
s
s
s
Managed … Race Unknown (%)
1.79
s
s
s
s
1.34
1.26
HMO (%)
a
a
a
a
a
a
a
Managed … )
5.22
11.14
7.11
5.87
9.05
5.81
6.76
HMO (%)
s
s
s
s
s
s
s
Managed … 33.47
30.63
30.04
HMO (%)
11.17
20.96
16.24
19.37
15.79
9.94
14.25
Managed
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www.ahrq.gov/sites/default/files/wysiwyg/cahps/news-and-events/events/webinars/hcbs-webcast-051623-brown.pdf
June 21, 2023 - Functional Tools (TEFT)
Demonstration
Applies across Delivery Systems
Used in both fee-for-service and
managed … Applicable in both fee-for-service and managed long-term services and
supports environments
7. … of analysis can vary
• State Medicaid agencies
• County or other non-state governmental entities
• Managed … care plans under managed long-term services and supports
programs
17
Other Important Considerations … aggregated results for analysis and
use
• The Lewin Group provides technical assistance to states, managed
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www.ahrq.gov/sites/default/files/wysiwyg/data/SyH-DR-PUF-Summary-Statistics-Medicaid-Person-Weighted.pdf
September 26, 2023 - enrolled 9,178,263 13.14 9,178,263 13.14
1: Enrolled 60,685,742 86.86 69,864,005 100.00
Medicaid Managed … enrolled 24,498,053 35.07 24,498,053 35.07
1: Enrolled 45,365,952 64.93 69,864,005 100.00
Medicaid Managed … enrolled 24,153,736 34.57 24,153,736 34.57
1: Enrolled 45,710,269 65.43 69,864,005 100.00
Medicaid Managed … Weighted Frequency Tables: PUF Medicaid Person File
15:39 Tuesday, September 26, 2023 10
Medicaid Managed … Weighted Frequency Tables: PUF Medicaid Person File
15:39 Tuesday, September 26, 2023 11
Medicaid Managed
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www.ahrq.gov/cahps/cahps-database/hcbs-database/index.html
January 01, 2025 - (HCBS) Survey Database is a central repository of survey data from State Medicaid agencies and the managed … help evaluate, compare, and improve the quality of services provided by both fee-for-service HCBS and managed
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www.ahrq.gov/patient-safety/settings/long-term-care/resource/hcbs/findings/find2.html
December 01, 2012 - changes to Medicaid requirements, such as limiting choice of provider through mandatory enrollment in managed … directly relevant to HCBS, but some States use Section 1115 waivers to cover long-term care under a managed … Section 1915(b/c) waivers allow States to enroll beneficiaries in a mandatory managed care program that … Due to data limitations—individual encounter data are not available for managed care participants—we … One in 10 HCBS participants was enrolled in a Medicare or Medicaid managed acute care plan.