Ginsburg S, Feldman R, Kates J.
AHSR FHSR Annu Meet Abstr Book. 1996; 13: 153-4.
The Lewin Group, Fairfax, VA 22031, USA.
RESEARCH OBJECTIVES: The increasing move to mandatory managed care for State Medicaid populations has had significant effects on safety net providers and their consumer populations. This study focused on the effect of this transition on Federally Qualified Health Centers, which have traditionally served a high proportion of Medicaid beneficiaries and have historically operated under a cost-based reimbursement system. The aim of this study was to evaluate the impact of 1115 waivers on FQHC administration, management, and service delivery; financial performance; and FQHC consumer perceptions. STUDY POPULATION: Six Federally Qualified Heatlh Centers, with multiple sites, in three states with 1115 waivers - Oregon, Hawaii, and Rhode Island were studied. STUDY DESIGN: This study examined a multitude of impacts on FQHC administration, management, and service delivery; financial performance; and consumer perceptions. For each of the three states, pre- and post- waiver study periods of six months were chosen to reflect waiver implementation. FQHCs were selected based on factors such as the size of their Medicaid populations; setting (urban/rural); diversity of their patient populations; and MIS/database capacity. Extensive phone and on-site interviews were conducted with FQHC staff and consumers, representatives of primary care associations, state Medicaid offices, and managed care plans. A review of written materials including waiver applications, terms and conditions, selected correspondence, and managed care contracts was conducted. Data analyses of Medicaid Cost Reports, BCRR data, and FQHC billing files were conducted for each six month study period to determine the impact on the financial performance of FQHCs. Case studies of each FQHC and each state were compiled based on analysis of qualitative and quantitative data. PRINCIPAL FINDINGS: 1115 waivers have multiple direct and indirect impacts on FQHCs such as: changes in Medicaid eligibility; changes in the benefit package; change from cost-based reimbursement to new payment method (e.g. combination capitation and fee for service); restriction of beneficiary freedom of choice; changes in provider referral relationships and networks; changes in access to specialty, ancillary, and hospital care; and changes in the marketplace. These impacts affect FQHCs and their consumers in both positive and negative ways, which vary by state and FQHC as well as reflect common themes. Common themes which emerged across states and FQHCs included the need for infrastructure and MIS development to track changes in patients, costs, payments, and services; the need to adjust staffing requirements to account for changes inpatient populations, size, and services; and the need to develop new kinds of referral and network relationships. Overall, this study indicated that FQHCs experienced both positive and negative impacts under 1115 waiver changes and emphasized the need for FQHCs to concentrate on improving their management capacity and developing appropriate data and management information systems to more accurately anticipate and track impacts due to changes in state Medicaid programs. RELEVANCE TO POLICY, HEALTH CARE DELIVERY: 1115 waivers provide States with the opportunity to dramatically change their Medicaid programs, including the opportunity to change eligibility and benefit packages. The impact of these changes, however, may have profound effects on safety net providers and their patient populations, particularly FQHCs which have traditionally served a high proportion of Medicaid beneficiaries and have historically operated under cost-based reimbursement. This study of the impacts of 1115 waivers on FQHCs not only has relevance to FQHCs throughout the country, it also provides valuable lessons and tools to many safety net providers who will be faced with changes due to increases in Medicaid managed care and related changes in the marketplace. For instance, this study developed and used a comprehensive tool for modeling financial impact which may be used to provide technical assistance to FQHCs adjusting to a changing financing environment. In addition, this study demonstrated the need for FQHCs to improve their management information systems and infrastructure in order to accommodate changes due to managed care. Finally, this study provides important information to federal and state governments seeking to provide technical assistance and support to safety net providers as they move to managed care.
Publication Types:
Keywords:
- Delivery of Health Care
- Eligibility Determination
- Hawaii
- Health Expenditures
- Health Planning
- Health Services Needs and Demand
- Humans
- Managed Care Programs
- Medicaid
- Oregon
- Public Policy
- Rhode Island
- economics
- methods
- organization & administration
- hsrmtgs
Other ID:
UI: 102222348
From Meeting Abstracts