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Purpose

This paper aims to examine the issue of quality of care in the US managed care system and to compare state‐level policies and programs. Specifically, it aims to describe five states which are making the most quality of care improvements.

Design/methodology/approach

This study examines the literature to identify states' care quality rankings. Additionally, five state case studies are presented to illustrate various programs approach to quality.

Findings

The paper finds that some states are better than others in their strategies to enhance quality of care. California, Florida, Maryland, Minnesota and Rhode Island are considered among the best. Thus, their programs are described.

Research limitations/implications

From a research perspective the study brings a renewed focus on various methods in which states invest to improve residents' quality of care.

Practical implications

From a practical standpoint, since quality of care is an important topic and interesting to all stakeholders in health care – policymakers, consumers, providers, and payers – readers can use the study's results to compare states' strategies and develop new ways to increase quality.

Originality/value

This study's value lies in the way it helps states to compare their performance over time and against other states as they make improvements to enhance quality.

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