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Monitoring of Managed Care Programs

ACA provides a range of products and services to assist human services agencies in the monitoring of managed care programs. ACA offerings in this area fall into three general categories:

• Monitoring of data submissions to ensure compliance with regulatory reporting requirements.
• Consulting, data management, and data analysis services to ensure the adequacy and integrity of data systems.
• Development of business intelligence solutions to support quality assurance and financial management efforts.

In an effort to contain costs, public human services programs are moving increasingly toward managed care models of program administration. Under some managed care models, a governmental or quasi-governmental agency contracts with a private managed care organization (MCO) to administer a human services program. As such programs are implemented, however, ongoing monitoring is essential to ensure not only that costs are being contained but that the quality of care and access to care are not adversely affected. This monitoring depends upon accurate and reliable information, and this, in turn, requires significant technical expertise in the area of health data systems and health data interpretation.

ACA provides a range of products and services to assist human services agencies in the monitoring of managed care programs.

Often the problem is not the absence of available data. In fact, the funding or regulatory authorities may demand a wide range of voluminous data submissions and this large volume may, itself, create a challenge for any monitoring agency. Additional difficulties lie in understanding the complexities and idiosyncrasies of the reporting requirements and determining whether they are being met on an ongoing basis. Finally, having ascertained the validity of submitted data with respect to applicable reporting requirements, the final challenge lies in extracting from this data meaningful information and using it to assess the performance of the program. ACA staff possess the expertise necessary to overcome these challenges and this expertise provides the basis for the variety of innovative solutions to meet the needs of the public welfare industry, in this area.

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