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Margaret A. McManus, MHS; Regina R. Graham, BA; Harriette B. Fox, MSS; Catherine M. Mercil, MSPH, RN; Charles E. Irwin Jr, MD

Arch Pediatr Adolesc Med. 2000;154:665-671.

Background  While children represent the largest population group enrolled in Medicaid managed care, little is known about the pediatric performance measures used by state Medicaid agencies.

Objective  To identify Medicaid managed care requirements for using Health Plan Employer Data and Information Set and other performance measures for children (defined as those aged 0-21 years in this study).

Design  A structured telephone survey of pediatric performance measures.

Participants  Survey respondents were state Medicaid officials responsible for managed care quality oversight in 39 states.

Main Outcome Measures  Percentage of states in 1998 with effectiveness-of-care measures on health promotion and disease prevention, early detection and screening, and acute and chronic illness; with use measures on preventive care, ambulatory care, pharmacy, inpatient hospital care, and mental health and chemical dependency services; and with access measures on primary care, low-birth-weight neonates delivered at appropriate facilities, and dental care.

Results  In 1998, state Medicaid agencies placed most of their emphasis on monitoring preventive care for children, with immunization rates being the primary focus. Far less attention was directed at assessing the treatment of acute illness. Although more than half of states monitored the treatment of chronic childhood conditions, they focused exclusively on asthma and selected mental health diagnoses.

Conclusions  States are still in the initial phases of designing and implementing quality oversight systems for Medicaid-insured children. Additional quality reporting requirements are clearly needed to assess the treatment of acute and chronic illness among children along with more age-specific reporting requirements.

From the Maternal & Child Health Policy Research Center, Washington, DC (Mss McManus, Graham, and Fox); Catherine Mercil Consulting, Arlington, Va (Ms Mercil); and the Division of Adolescent Medicine, University of California, San Francisco (Dr Irwin).

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