A “best practices” strategy to improve quality in Medicaid managed care plans

Abstract

Medicaid managed care is delivered through organizations operating in very heterogeneous environments that confront similar barriers to success. Because Medicaid managed care is implemented differently in each state, health plans have been isolated from each other and have not had an opportunity to learn how others may have surmounted commonly encountered barriers. After interviewing Medicaid health plan medical directors, we developed a learning collaborative model based on shared categories of problems they would need to address before they could implement a successful improvement strategy in an important clinical area, birth outcome improvement. Under the Best Clinical and Administrative Practices initiative, we have brought together 12 Medicaid health plans to work together on strategies and specific objectives for overcoming obstacles to improvement. Evaluations by participants have been positive, and they appear to be making a number of specific organizational changes based on learning from the collaboratives. We will be employing this organizational development model to a series of clinically and administratively important topics over the next few years.

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