Landon BE, Epstein AM; Association for Health Services Research. Meeting.

Abstr Book Assoc Health Serv Res Meet. 1999; 16: 133-4.

Department of Health Care Policy, Harvard Medical School, Boston, MA 02115, USA.

RESEARCH OBJECTIVE: Rapid expansion of Medicaid managed care has raised concerns about the capacity and willingness of health plans enrolling Medicaid beneficiaries to provide high quality care. Recently, legislation has facilitated market entry of "Medicaid" plans, health plans that draw most of their enrollment from the Medicaid population. Because little information is available on the types of health plans now caring for Medicaid beneficiaries and their quality management practices, we designed a national survey to assess the organizational characteristics related to quality of care of health plans that provide care to this population. STUDY DESIGN: After randomly selecting the District of Columbia and 11 states, we surveyed all 154 health plans in these localities that provided pre-paid general medical care to Medicaid beneficiaries during June 1997. Eighty-four percent of these plans (130/154) responded to the survey. PRINCIPAL FINDINGS: One-half of the respondents were "Medicaid" plans with 75% or more of enrollees drawn from the Medicaid population. Medicaid plans tended to be smaller and newer than commercial plans that also served the Medicaid population. They had more enabling programs targeting the special needs of the Medicaid population such as inadequate transportation (85% of Medicaid plans v. 62% of commercial plans, p=.003) and lack of telephone service (56% v. 36% respectively, p=.053). Overall, 71 percent of Medicaid plans versus 43 percent of commercial plans had enabling programs targeted at six or more of the eight special needs we specified (p=.001). While commercial plans had a higher proportion of board certified primary care physicians (81% v. 73%, p=.01), we found no major differences between Medicaid plans and commercial plans in collection and dissemination of performance measures, designation of specific areas for quality improvement, or use of disease management programs targeted at conditions prevalent in the Medicaid population. Neither commercial nor Medicaid plans reported high success in improving quality of care. CONCLUSIONS: While Medicaid plans resemble commercial plans serving the Medicaid population in many aspects of quality management, they are more likely to target programs to the specific needs of the Medicaid population. Neither commercial nor Medicaid plans, however, have notably strong records in actual quality improvement. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: Federal waivers and the Balanced Budget Act of 1997 have opened the doors for health plans that serve predominantly the Medicaid population. While further research is warranted, these results support this recent change in policy.

Publication Types:

• Meeting Abstracts

Keywords:

• Child Health Services
• Data Collection
• District of Columbia
• Health
• Health Services Accessibility
• Health Services Research
• Insurance, Health
• Managed Care Programs
• Medicaid
• Preventive Health Services
• Quality Assurance, Health Care
• Quality Indicators, Health Care
• Quality of Health Care
• State Health Plans
• economics
• hsrmtgs

Other ID:

• HTX/20602741

UI: 102194430

From Meeting Abstracts