Medicaid managed care. From cost savings to accountability and quality improvement.

Medicaid managed care is a work in progress. This article provides a brief historical overview of Medicaid managed care from the early 1980s to the late 1990s and offers insight into some of the major operational, fiscal, and political realities of implementing managed care in a Medicaid context. This article also attempts to show that a major advantage of managed care is having a more accountable health care system. Accountability can bring quality improvements to a system that often lacked the ability to measure performance and results under Medicaid fee-for-service. Subsequent articles in this journal demonstrate how states working together with managed care organizations and quality review organizations can better define, measure, and use quality information to improve their Medicaid managed care programs.