D.C. Medicaid Managed Care Plans Show Improvement Over Last Year, Study Finds

The "overall quality" of six Medicaid managed care plans in Washington, D.C., improved last year, according to a review of patient records, the Washington Post reports. The study, which was prepared for District officials, found that some of the HMOs "lagged far behind competitors." Completed by the Delmarva Foundation for Medical Care -- which gauges the quality of care provided by doctors, hospitals and health plans -- the study reviewed 2,000 patient records and examined 18 "internal systems" used by HMOs to monitor performance. Such systems include documenting problems, following procedures to address problems and proving that any problem issues have been resolved. The District sets a "passing" grade at 80%, but some plans failed or just met that grade. Health Services for Children with Special Needs, which covers 2,600 children with disabilities, scored 79% on the review. Debbie Zients, vice president of operations for the health plan, said that the review standards "are not geared" to the HMO's approach, which includes some "unusual" types of care, such as transportation and "specialized" follow up treatment. However, she added that is "no excuse for failing to pass." D.C. Chartered Health Plan, which covers 26,000 people, scored 83% but had problems with its written quality plan, quality assurance and physician participation. With an overall score of 99%, Amerigroup Corp.'s report was "virtually all good." The HMO's COO, Jane Thompson, said the health plan "devote[d] significant resources" to meeting the requirements. The Post reports that city officials will use the report to determine in which areas the health plans must improve. D.C. Medicaid Deputy Director Wanda Tucker said that the evaluations are a "tool for managers" and should not be used as a guide for the public. She added, "The value of the report to us is it tells us where plans are doing less well, and when we sit down with them on a corrective action plan, we know what areas to focus on." Medicaid Director Herbet Weldon said, "It doesn't necessarily mean the [plans that] did poorly provided poor quality care" (Goldstein, Washington Post, 10/4). For more information about health policy in the District of Columbia, go to State Health Facts Online.