As the Kansas Department of Social and Rehabilitation continues implementation of managed care programs that will provide medical care to over 150,000 Medicaid recipients in Kansas by July, 1997, it is also creating a system-wide quality management program that will lead to better health outcomes and cost containment.

The quality management system being integrated into the health care delivery system is based on tracking health outcomes for Medicaid beneficiaries. The emphasis being placed on raising the quality of medical care and improving access for Medicaid beneficiaries should help eliminate concerns that health care will suffer under managed care programs.

In fact, the opposite result will occur," said SRS Secretary Rochelle Chronister. The overall quality management program -- together with more health care providers coming in to Medicaid managed care

programs and an emphasis on preventive care -- will increase the quality, access and appropriate utilization of medical services.

This will lead not only to better health for beneficiaries but also, as health outcomes improve, help contain costs," the Secretary said.

The quality management program for Kansas Medicaid will no longer focus only on individual episodes of health care gone bad. Inappropriate care will still be investigated and state officials will continue to work to have taxpayer money returned when fraud is confirmed.

But the new quality management system being put in place will also look at the overall level of care given to consumers and seek to raise that level through a cooperative provider education process.

The expansion of managed care holds great promise for improving the overall quality and access of care for Medicaid beneficiaries," said Ann Koci, commissioner of Adult and Medical Services for SRS. We now know you don't improve overall care for patients by just focusing on tracking down a few bad providers.

While we will continue our strong efforts to crack down on fraud in the Medicaid program, our overall goal is to work together with health care providers to raise the level of care as a whole," Koci said.

In the middle of the major change in Medicaid quality management is the Kansas Foundation for Medical Care (KFMC), under contract with SRS as the federally-mandated External Quality Review Organization (EQRO). Unlike many other states who use an EQRO only to respond to complaints and grievances in managed care programs, KFMC will coordinate and evaluate quality management activities throughout the Medicaid system.

This includes coordination and evaluation of quality management activities in the three SRS managed care programs -- HealthConnect, PrimeCare Kansas, and Community Care of Kansas -- but also in the fee-for-service Medicaid operation, in pharmacy, and in the hospital inpatient program. KFMC will also coordinate several health care outcomes studies per year and will review mandated health care studies done by each of the HMOs under contract with SRS.

Examples of the types of studies to be conducted may include the

level of pre-natal care being provided to pregnant women with a medical card or the number of immunizations provided to children. Koci said KFMC's job is to coordinate all quality management programs. They will help us pull it all together and make it one Medicaid program, not separate programs. We need to get an overall picture of the health care being provided the Medicaid population."

Mike Speight, chief operating officer for KFMC, said there has been a philosophic change in direction concerning quality management. In the past KFMC reviews of utilization and quality assurance for SRS had focused on individual episodes of care.

The theory was, in general, care was good, but we needed to find the few bad apples and either educate them or kick them out of the program," Speight said. That approach was adversarial, with payment consequences to the provider."

Under quality management, however, Speight said the emphasis will change.

You don't improve overall health care just by looking at the margins," he said. The best way to improve health care for the entire population is to stress education and work in a cooperative way to make needed changes. Then measure the effect of the changes, and, if necessary, change again."

Speight said SRS has created a unique approach to quality management that will be copied by other states.

Quality improvement is ingrained in all parts of the medical program," he said. Assuming we can pull it off, Kansas will be a model for all other states, who tend to do quality control piecemeal. Obviously, a lot of coordination will be needed. It will require all of us to make philosophic shifts at the same time. It requires people and organizations to work together.

And, lastly, it will require a change of attitude from medical providers, concerning us," Speight said. They are used to thinking of us as trouble...they think the EQRO does chart reviews and denies payment. And now, we're going to them and saying 'that's over; now we're about collaboration.'"

Page Last Updated: May 29, 2001