Quality oversight for Medicaid managed care plans: impact on providers.

Overview

The purpose of this study was to describe managed care organization (MCO)-provider interactions around quality monitoring in Medicaid managed care. Heads of ambulatory pediatrics in institutions and private providers in offices in New York City (NYC) responded to questions regarding several forms of MCO-provider communications around quality. It appears that the current quality monitoring review process undertaken by managed care plans in provider sites in NYC is duplicative and overlapping. Feedback from the quality reviews is not being received by the providers who are giving care and incentives/disincentives are not felt. These constitute severe limitations to the current system of quality oversight.