Quality Strategy

The Centers for Medicare & Medicaid Services (CMS) requires in 42 CFR §438.340, each state contracting with a managed care organization (MCO) to draft and implement a written quality strategy for assessing and improving the quality of health care and services furnished by the MCO.  At least every three years, Texas must review and update its quality strategy. The results of the review must be made available to the public, and the updated strategy must be submitted to the CMS. The quality strategy is reviewed each year by the External Quality Review Organization in its Annual Technical Report.

HHSC uses its Managed Care Quality Strategy to assess and improve the quality of health care and services provided through the managed care system, prioritizing the following goals:

• Promote optimal health through prevention and by engaging people, families, communities, and the health care system to optimize health outcomes
• Keep patients free from harm by building a safer health care system
• Promote effective practices for people with chronic, complex, and serious conditions to improve people’s quality of life and independence, reduce mortality rates, and better manage the leading drivers of health care costs.
• Use high quality health information for people, families, communities, and the health care system to make data driven decisions to improve quality health care for all Texans.

Transforming Medicaid and the Children’s Health Insurance Program into a value-based system is a long-term endeavor involving many decisions and coordinated actions by HHSC programs and stakeholders. HHSC constantly works to make sure people get better healthcare and stay healthy, all while keeping the costs under control.

HHSC submitted the Texas Managed Care Strategy (PDF) to CMS in September 2024.

For more information, email MCD Managed Care Quality.