But with block grants, states have taken a much more aggressive role in how to manage the program. To put it simply, states see the ever-rising costs of Medicaid as the No. 1 issue and managed care as the best solution for reducing those costs. But shifting patients into managed care isn't as easy as it sounds. States used to pay a fee for each individual service. Under managed care, states pay for a beneficiary's services through capitation fees, which have changed the dynamics of reimbursement for providers and state Medicaid programs, resulting in new tensions and greater scrutiny.
Providers also have less incentive to provide states with accurate and timely data.
That's because states need reliable data to understand how best to improve the quality of managed care, which means monitoring, evaluating and influencing a managed-care plan's performance. A DSS consists of hardware, analytical software and a database that gives the user timely access to data that hasn't been duplicated, is consistent, has been integrated and has passed through standard integrity controls. In 1996, HCFA surveyed the states and, out of 42 responses, found that 17 states already had a DSS in place or were building one. Another 22 states planned to have a DSS within the next two years. The survey found that technical analysts were the most frequent DSS users, in terms of creating and analyzing reports, while senior staff were least likely to use the system.