Changes in Health Plans Serving Medicaid, 1993-1996

Felt-Lisk, Suzanne; Yang, Sara

doi:10.1377/hlthaff.16.5.125

Cited by 29 publications

(12 citation statements)

References 1 publication

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“…The overall penetration rate across the CTS-HS markets increased from 23.6% in June 1996 to 40.1% in June 2002. (These estimates for the CTS-HS markets are generally consistent with those released by CMS, although the discrepancies between the two may result from the CTS-HS being limited to only 51 select urban MSAs in the United States) The penetration rate by commercial HMOs peaked at 14.1% in 1998 and then declined to 12.2% by 2002 as some commercial plans pulled out; these patterns are also consistent with Felt-Lisk and Yang (1997) and Long and Yemane (2005). The penetration rate of Medicaid-dominant HMOs increased throughout the study period from 15.4% in 1996 to 27.9% in 2002.…”

Section: Control Variablessupporting

confidence: 80%

Using HMOs to serve the Medicaid population: what are the effects on utilization and does the type of HMO matter?

Herring

Adams

2011

Health Econ.

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States have increasingly used Health Maintenance Organizations (HMOs) to provide medical services to the Medicaid population. However, the effects of these initiatives on total health-care expenses, the mix of utilization, and access to care remain unclear. We examine the effect of changes in Medicaid HMO penetration between 1996 and 2002 on these outcomes using data for the nonelderly Medicaid population in the Community Tracking Study's Household Survey. We develop market-level measures of Medicaid HMO penetration from CMS and InterStudy data, distinguish whether the HMOs specialize in serving the Medicaid population, and use a market fixed-effects model to focus on changes in HMO penetration rates over time. Although limited by imprecise estimates, we find some evidence that utilization and access are related to the market penetration rates of commercial and Medicaid-dominant HMOs, but the pattern of results we observe does not appear to be consistent with welfare improvements.

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Section: Control Variablessupporting

confidence: 80%

Using HMOs to serve the Medicaid population: what are the effects on utilization and does the type of HMO matter?

Herring

Adams

2011

Health Econ.

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“…These withdrawals are of concern since one of the goals of managed care was to provide access to mainstream providers and as commercial plans exit, states are increasingly reliant on Medicaid‐dominant HMOs (Felt‐Lisk 2000). Medicaid‐dominant plans tend to be smaller, based in urban underserved areas, and form their provider networks around physicians and health centers who historically served low‐income populations (Felt‐Lisk and Yang 1997).…”

Section: Introductionmentioning

confidence: 99%

Medicaid HMO Penetration and Its Mix: Did Increased Penetration Affect Physician Participation in Urban Markets?

Adams

Herring

2007

Health Services Research

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Objective. To use changes in Medicaid health maintenance organization (HMO) penetration across markets over time to test for effects on the extent of Medicaid participation among physicians and to test for differences in the effects of increased use of commercial versus Medicaid-dominant plans within the market. Data Sources/Study Setting. The nationally representative Community Tracking Study's Physician Survey for three periods (1996-1997, 1998-1999, and 2000-2001) on 29,866 physicians combined with Centers for Medicare and Medicaid Services (CMS) and InterStudy data. Study Design. Market-level estimates of Medicaid HMO penetration are used to test for (1) any participation in Medicaid and (2) the degree to which physicians have an ''open'' (i.e., nonlimited) practice accepting new Medicaid patients. Models account for physician, firm, and local characteristics, Medicaid relative payment levels adjusted for geographic variation in practice costs, and market-level fixed effects. Principal Findings. There is a positive effect of increases in commercial Medicaid HMO penetration on the odds of accepting new Medicaid patients among all physicians, and in particular, among office-based physicians. In contrast, there is no effect, positive or negative, from expanding the penetration of Medicaid-dominant HMO plans within the market. Increases in cost-adjusted Medicaid fees, relative to Medicare levels, were associated with increases in the odds of participation and of physicians having an ''open'' Medicaid practice. Provider characteristics that consistently lower participation among all physicians include being older, board certified, a U.S. graduate and a solo practitioner. Conclusions. The effects of Medicaid HMO penetration on physician participation vary by the type of plan. If states are able to attract and retain commercial plans, participation by office-based physicians is likely to increase in a way that opens existing practices to more new Medicaid patients. Other policy variables that affect participation include the presence of a federally qualified health center (FQHC) Early research on Medicaid managed care found that shifts in the type and site of care (e.g., lower specialty care and emergency room [ER] use) occurred but found little evidence of increased physician visits, preventive care or changes in hospitalizations; cost savings appeared minimal but enrollees reported no worse satisfaction or quality (Hurley et al. 1993; Kaiser Commission 1995). More recent research continues to find mixed results for utilization and access. Duggan (2004) found increased state spending and no corresponding improvement in infant health outcomes when welfare-related enrollees were mandated to enroll in Medicaid HMOs.One goal of Medicaid managed care was to ''mainstream'' Medicaid enrollees into private physician practices. While Medicaid managed care did appear to improve some aspects of access in some geographic areas, less is known about how it changed the participation of office-based physicians or how local ma...

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“…State Medicaid programs, the primary providers of health insurance to lowincome children, are increasingly turning to managed care programs in an effort to reduce costs and coordinate care. 11 Studies 12,13 directly comparing health maintenance organization (HMO) with feefor-service care for pediatric Medicaid enrollees have shown mixed results. Be-cause it is a common chronic disease with preventable morbidity and measurable outcomes, childhood asthma is a particularly appropriate sentinel or tracer condition for assessment of Medicaid services.…”

mentioning

confidence: 99%

Comparing Asthma Care for Medicaid and Non-Medicaid Children in a Health Maintenance Organization

Finkelstein¹,

Barton²,

Donahue³

et al. 2000

Arch Pediatr Adolesc Med

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Objective: To compare ambulatory visit patterns, rates of medication use, and emergency department and hospital utilization for children with asthma covered under Medicaid and commercial payers within the same health maintenance organization (HMO).Design: Retrospective cohort study.Setting: Eleven staff-model pediatric departments of an HMO.Patients: A total of 1928 Medicaid and 11 007 nonMedicaid children aged 2 to 18 years with at least 1 encounter with a diagnosis of asthma between October 1, 1991, and September 30, 1996. Methods:We linked patient-level data from the HMO's automated medical record system for ambulatory encounters, a claims system for emergency department and hospital care, and an automated pharmacy dispensing database. Medicaid and non-Medicaid patients were compared for all encounter types and for prescribing and dispensing of ␤-agonist and controller medications (inhaled corticosteroids and cromolyn sodium). Incidence rate ratios were calculated from Poisson regression models to control for age, sex, and, when appropriate, ␤-agonist dispensing rate. The number of refills authorized on each prescription and the fraction of medications dispensed as refills compared with new prescriptions were compared for Medicaid and non-Medicaid patients.Results: Medicaid-insured children in the HMO were 1.4 times (95% confidence interval, 1.2-1.5) more likely to receive care in emergency departments and 1.3 times (95% confidence interval, 1.1-1.5) more likely to be hospitalized for their asthma compared with non-Medicaid members. Medicaid and non-Medicaid enrollees had similar yearly rates of nonurgent (1.32 vs 1.17) and urgent (0.38 vs 0.31) ambulatory visits. ␤-Agonists were dispensed roughly equally to Medicaid and non-Medicaid members. Although Medicaid patients were less likely to have controller medications dispensed (relative risk, 0.72; 95% confidence interval, 0.69-0.74), they were equally likely to have them prescribed.Conclusions: Differences in ambulatory contact for Medicaid members do not explain the higher rates of emergency department visits and hospitalization in this population. Reasons for lower rates of dispensing of controller medications should continue to be investigated as one cause of increased morbidity for low-income children with asthma.

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Changes in Health Plans Serving Medicaid, 1993-1996

Cited by 29 publications

References 1 publication

Using HMOs to serve the Medicaid population: what are the effects on utilization and does the type of HMO matter?

Using HMOs to serve the Medicaid population: what are the effects on utilization and does the type of HMO matter?

Medicaid HMO Penetration and Its Mix: Did Increased Penetration Affect Physician Participation in Urban Markets?

Comparing Asthma Care for Medicaid and Non-Medicaid Children in a Health Maintenance Organization

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