Medicaid Managed Care Performance Measures

In March 2018, in response to Article II, HHSC Rider 45 of the 2018-19 General Appropriations Act (85(R) SB 1), the Meadow Mental Health Policy Institute (MMHPI) reviewed performance measures for individuals with serious mental illness (SMI) in Texas and other states’ Medicaid managed care programs, focusing particularly on widely-used Healthcare Effectiveness Data and Information Set (HEDIS) measures.

The use of performance measures that address physical and behavioral health status is important, since individuals with SMI tend to experience shortened life expectancy and high costs for co-morbid, chronic health concerns (e.g., diabetes, hypertension, heart disease) as a result of poorer overall health and the challenges associated with behavioral health conditions.

Most quality management programs have performance metrics that measure processes (e.g., member access to follow-up care upon hospital discharge) and outcomes (e.g., helping people recover and gain the skills needed to benefit from less intensive care). Both process and outcome measures are useful. Typically, states and/or managed care organizations (MCOs) select several performance measures that merit additional payments to the MCO and/or the providers when positive results are achieved.

This white paper also includes recommendations to Texas Health and Human Services Commission for improved performance monitoring.

Read or download the full white paper Medicaid Managed Care Performance Measures Recommendations.