Journal Article

Thinking about clinical outcomes in Medicaid

With Kevin Quinn, MA, EMT-P, Dawn Weimar, RN

Published in The Journal of Ambulatory Care Management
by Quinn, Kevin MA; Weimar, Dawn RN; Gray, Jeffrey RN; Davies, Bud MSc

As Medicaid expands in scope and influence, it is evolving toward being a “purchaser” of quality health care. This commentary discusses measurement and incentivization of clinical outcomes in Medicaid. Advantages and disadvantages of outcome versus process measures are discussed. Distinctions are drawn between the roles of Medicare and Medicaid, including the implications of the growth in Medicaid managed care. Medicaid‘s influence is particularly notable for obstetric, pediatric, newborn, and long-term care. We provide data on 3 Medicaid outcomes: potentially preventable hospital admissions, readmissions, and complications. The commentary concludes with suggestions for choosing and implementing outcome-oriented value-based purchasing initiatives in Medicaid.

Publication Date: 2016

3M methodologies use in research: 3M Potentially Preventable Readmissions (PPRs), 3M Potentially Preventable Admissions (PPAs), 3M Potentially Preventable Complications (PPCs)

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Source: Quinn K, Weimar D, Gray J, Davies B. Thinking about clinical outcomes in Medicaid. The Journal of Ambulatory Care Management. 2016;39(2).