Journal of Urban Health

, Volume 77, Issue 4, pp 573–591 | Cite as

Problems with quality monitoring for Medicaid managed care: Perceptions of institutional and private providers in New York City

  • Gerry Fairbrother
  • Stephen Friedman
  • Gary C. Butts
  • Judith Cukor
  • Anthony Tassi
Original Article: Medicaid Managed Care


The study objective was to examine quality oversight efforts by Medicaid managed care organizations (MCOs) for children in a sample of ambulatory care institutions and private practices in New York City. This was a cross-sectional study of quality assurance priorities and strategies of MCOs and their impact date in institutions in New York City. Data were from structured interviews administered in 1997 to medical directors in the eight largest MCOs; and medical directors, heads of ambulatory pediatrics, and institutional pediatricians in a random sample of 15 institutions and 20 private office-based providers. Medical directors in MCOs reported that their main priority areas were the preventive care measures (e.g., immunization and lead screening) that they must report to the state. Knowledge of these MCO priority areas and monitoring activities was high for medical directors in the random sample, but decreased from these medical directors to heads of ambulatory pediatrics to institutional pediatricians, with the differences between the medical directors and institutional pediatricians significant (P<.05). However, 96% of the institutional pedians reported knowing their own institution's priorities and monitoring activities. In contrast, most private pediatricians reported they knew MCO priorities and monitoring activities (80%). Less than 33% of any group reported activities as “very effective” or felt any incentive to improve performance. There was a high level of overlap in provider networks, with institutions and private providers having children in many MCOs, and MCOs having children in many sites.

Key Words

Institutional providers Medicaid managed care Monitoring Quality 


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  1. 1.
    Health Care Financing Administration. National Summary of State Medicaid Managed Care Programs and Enrollment. Managed Care Trends. June 30, 1999. Available at: http// Accessed August 1, 2000.Google Scholar
  2. 2.
    United Hospital Fund. Potal enrollment, Medicaid managed care: New York City 1993–February 2000.Currents. Spring 2000;5(1):1.Google Scholar
  3. 3.
    Health Care Financing Administration. New York Statewide Health Reform Demonstration fact sheet. Revised November 8, 1999. Available at: http// medicaid/nyfact.htm. Accessed August 1, 2000.Google Scholar
  4. 4.
    Deal LW, Shiono PH, Behrman RE. Children and managed health care: analysis and recommendations.Future Child. 1998;8:4–24.PubMedGoogle Scholar
  5. 5.
    Lipson DJ, Bernstein AB. Doing the right thing: the role of market forces and public policy in managed care organizationś performance on child health. In: Stein RE, ed.Health Care for Children: What's Right, What's Wrong, What's Next. New York, NY: United Hospital Fund of New York; 1997;237–260.Google Scholar
  6. 6.
    Landon BE, Tobias C, Epstein AM. Quality management by state Medicaid agencies converting to managed care: plans and current practice.JAMA. 1998;279:211–216.PubMedGoogle Scholar
  7. 7.
    Inglehart JK. The national committee for quality assurance.N Engl J Med. 1996;335: 995–1000.Google Scholar
  8. 8.
    New York State Department of Health.1997 Quality Assurance Reporting Requirements: a Report on Managed Care Performance. Albany, NY: Office of Managed Care; March 1999.Google Scholar
  9. 9.
    New York City Department of Health.Current Medicaid Managed Care Contract. Section 16. New York, NY: Division of Health Care; July 1996.Google Scholar
  10. 10.
    Berenson RA. Bringing collaboration into the market paradigm.Health Aff. 1998;17(6): 128–137.CrossRefGoogle Scholar
  11. 11.
    United Hospital Fund. Office-based physicians in Medicaid managed care.Currents. Summer 1999;4(2):1–7.Google Scholar
  12. 12.
    Rowland D, Salganicoff A. Commentary: lessons from Medicaid—improving access to office-based physician care for the low-income population.Am J Public Health. 1994; 84:550–552.PubMedGoogle Scholar
  13. 13.
    Callahan EJ, Bertakis KD. A comparison of physician-patient interaction at free-forservice and HMO sites.Family Pract Res J. 1993;13:171–178.Google Scholar
  14. 14.
    Hohlen MM, Manheim LM, Fleming GV, et al. Access to office-based physicians under capitation reimbursement and Medicaid case management: findings from the Children's Medicaid Program.Med Care. 1990;28:59–68.PubMedGoogle Scholar
  15. 15.
    United Hospital Fund. Medicaid managed care enrollment New York City July 1997.Currents. Summer 1997;2(2):8.Google Scholar
  16. 16.
    United Hospital Fund.New York City Community Health Atlas. New York, NY: United Hospital Fund; 1994.Google Scholar
  17. 17.
    Fairbrother G, Friedman S, Hanson K, Butts GC. Effect of the Vaccines for Children program on inner-city neighborhood physicians.Arch Pediatr Adolesc Med. 1997;151:1229–1235.PubMedGoogle Scholar
  18. 18.
    National Committee for Quality Assurance. HEDIS 3.0 Health Plan Employer Data and Information Set.Technical Specifications Vol. 2. Washington, DC: National Committee for Quality Assurance; October 1996.Google Scholar
  19. 19.
    New York State Department of Health.1996 Managed Care Quality Assurance Reporting Requirements for Medicaid and Commercial Populations. Albany, NY: Office of Managed Care; 1998.Google Scholar
  20. 20.
    United Hospital Fund. Findings: primary care networks in Medicaid managed care.Currents. Fall 1998;3(3):6–7.Google Scholar
  21. 21.
    McCue MJ, Hurley RE, Draper DA, Jurgensen M. Reversal of fortune: commercial HMOs in the Medicaid market.Health Aff. 1999;18:223–230.CrossRefGoogle Scholar
  22. 22.
    New York City Department of Health.Medicaid and Child Health Plus Primary Care Provider Directories. New York, NY: Division of Health Care Access; July 2000.Google Scholar
  23. 23.
    Wicks EK, Meyer JA. Making report cards work.Health Aff. 1999;18:152–155.CrossRefGoogle Scholar
  24. 24.
    Short PF, Cantor J, Monheit A. The dynamics of Medicaid enrollment.Inquiry. 1998; 25:504–516.Google Scholar
  25. 25.
    New York State Department of Health. Monthly Medicaid Managed Care Enrollment and Disenrollment Report 1998. Available at: consumer/medicaid/main/htm.Accessed August 2, 2000.Google Scholar
  26. 26.
    Berenson RA. Beyond competition.Health Aff. 1997;16:171–180.CrossRefGoogle Scholar
  27. 27.
    Magnan S, Solberg LI, Kottke TK, et al. Improve: bridge over troubled waters.J Qual Improvement. 1998;24:566–578.Google Scholar

Copyright information

© The New York Academy of Medicine 2000

Authors and Affiliations

  • Gerry Fairbrother
    • 1
  • Stephen Friedman
    • 2
  • Gary C. Butts
    • 3
  • Judith Cukor
    • 4
  • Anthony Tassi
    • 5
  1. 1.Department of Epidemiology and Social MedicineMontefiore Medical Center/Albert Einstein College of MedicineBronxUSA
  2. 2.New York City Department of HealthUSA
  3. 3.Office for Multicultural and Community AffairsMount Sinai School of MedicineUSA
  4. 4.Montefiore Medical CenterFerkauf Graduate School of PsychologyUSA
  5. 5.Kalkines, Arky, Zall, BernsteinLLPUSA

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