Honesty as good policy: evaluating Maryland's Medicaid managed care program.

Throughout the 1990S, the states launched many large-scale innovations in health care financing and delivery. The demands associated with designing, implementing, and managing such initiatives compete for those resources needed to evaluate the impact of the innovations. But without a good faith effort to launch a credible evaluation, innovative and controversial programs may not be able to be sustained. Striking a balance between advocating for change and honestly determining how well the desired changes have been achieved is a delicate and daunting task, and state policymakers often do not spend much time evaluating their efforts, even though this may be critical to the success of their programs. This article describes one state’s assessment of a statewide, prepaid, Medicaid managed care program. We look at the evaluation as both an exercise in policy analysis and an indication of the response to various constituencies’ concerns. Three of us either worked for the state or contracted with the state to help evaluate the program. We begin this article with the history of managed care in Maryland and then discuss the need for its evaluation. We use some of the findings from the evaluation to illustrate the state’s proactive and reactive response to its Medicaid managed care program and then examine the rollout of the evaluation and its key recommendations. Finally, we discuss the lessons