Health services appraisal and the transition to Medicaid Managed Care from fee for service

Owen, Randall; Heller, Tamar; Bowers, Anne

doi:10.1016/j.dhjo.2015.10.004

Cited by 5 publications

(5 citation statements)

References 49 publications

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“…Because provider networks were slow to develop during the initial phase, disruptions in services might have occurred. A survey conducted by the ICP evaluation team revealed that nearly two-thirds of ICP enrollees could not continue to see at least one provider and one-third had to find new providers after transitioning from FFS to ICP (Owen, Heller, & Bowers, 2016). …”

Section: Discussionmentioning

confidence: 99%

Impacts of an Integrated Medicaid Managed Care Program for Adults with Behavioral Health Conditions: The Experience of Illinois

Xiang

Owen

Langi

et al. 2018

Adm Policy Ment Health

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This study assessed the impact of the Integrated Care Program (ICP), a new Medicaid managed care model in Illinois, on health services utilization and costs for adults with behavioral health conditions. Data sources included Medicaid claims, encounter records, and state payment data for 28,127 persons with a behavioral health diagnosis. Difference-in-differences models, in conjunction with propensity score weighting, were used to compare utilization and costs between ICP enrollees and a fee-for-service (FFS) comparison group. The model considered the impact of the SMART Act, which restricted access to care for the comparison group. Before the SMART Act, ICP was associated with 2.8 fewer all-cause primary care visits, 34.6 fewer behavioral health-specific outpatient visits, and 2.5 fewer all-cause inpatient admissions per 100 persons per month, and $228 lower total costs per member per month relative to the FFS group. After the SMART Act, ICP enrollees had increased outpatient and dental services utilization without significantly higher costs. The relative increase in utilization was due primarily to decreased utilization in the restricted FFS group after the SMART Act. By the end of the study period, the ICP group had 13.3 more all-cause primary care visits, 1.5 more emergency department visits, and 1.4 more dental visits per 100 persons per month relative to the FFS program. A fully-capitated, integrated managed care program has the potential to reduce overall Medicaid costs for people with behavioral health conditions without negative effects on service utilization.

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Section: Discussionmentioning

confidence: 99%

Impacts of an Integrated Medicaid Managed Care Program for Adults with Behavioral Health Conditions: The Experience of Illinois

Xiang

Owen

Langi

et al. 2018

Adm Policy Ment Health

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“…Only 15.4% of the MMC group (and 24.0% of the FFS group) maintained a relationship with the usual provider from the baseline period. Previous survey research has shown the importance of relationships with providers over the years: Study results show that after weighting the FFS group to match MMC, the MMC group was significantly less likely to maintain those longitudinal relationships (Owen et al, 2016). This finding backs advocate fears that provider relationships would be disrupted during the transition from FFS to MMC.…”

Section: Discussion Of Policy Implicationsmentioning

confidence: 99%

“…Previous research has focused on MMC processes and associated outcomes, such as patient activation and engagement with their care for the general Medicaid population (Hibbard & Greene, 2013; Hibbard, Greene, & Tusler, 2009). Research specific to people with disabilities in MMC has explored the relationship between care coordination experiences and perceptions of health care or unmet medical needs (Bowers, Owen, & Heller, 2017); enrollee and family experiences during the transition from FFS to MMC, especially around appraisals of the health care services (Owen, Heller, & Bowers, 2016); and barriers, facilitators, and unmet needs during the transition (Gibbons, Owen, & Heller, 2016; Williamson et al, 2016).…”

Section: People With Disabilities and MMCmentioning

confidence: 99%

“…In their recommendations, national organizations (Consortium for Citizens With Disabilities, 2012; Kaiser Commission on Medicaid and the Uninsured, 2012; National Council on Disability, 2012) note the importance of developing strong provider networks before MMC starts to operate to ensure a smooth transition. The strength of enrollees’ relationships with PCPs can be characterized by three aspects: preventive, annual visitations (Allen, Wieland, Griffin, & Gozalo, 2009; Kroll, Jones, Kehn, & Neri, 2006); continuity of care (COC) throughout the year (Nutting, Goodwin, Flocke, Zyzanski, & Stange, 2003; Stransky & Reichard, 2019); and maintaining longitudinal relationships across years (including before and after MMC transitions; Owen et al, 2016). Enrollees in managed care programs should visit a PCP regularly, for instance, at least once a year, to manage preexisting conditions and to receive preventive services (Allen et al, 2009; Stransky & Reichard, 2019).…”

Section: Pcps and MMCmentioning

confidence: 99%

“…Stransky and Reichard (2019) suggested that people with complex disabilities are less likely to have repeat visits with a PCP; they speculated this could be strategic if an individual is seeking a fresh opinion or health care solution that is not rooted in their history. Nonetheless, people with disabilities who transitioned to MMC and mostly saw the same providers from FFS have reported better health care and fewer unmet medical needs than people who saw fewer of their previous providers (Owen et al, 2016).…”

Section: Pcps and MMCmentioning

confidence: 99%

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Utilization of and Relationships With Primary Care Providers During the Transition to Medicaid Managed Care

Owen

Crabb

Stober

et al. 2019

Journal of Disability Policy Studies

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The objective of this study was to determine whether seniors and disabled adults in Illinois’s Medicaid managed care (MMC) were more likely to see, maintain longitudinal relationships with, and have continuity of care with a primary care provider (PCP) compared with fee-for-service (FFS) Medicaid enrollees. Medicaid PCP service claims for 13,221 MMC and 54,625 FFS enrollees were analyzed using an inverse propensity score weighted difference-in-differences design to match the groups by demographic characteristics and historical Medicaid utilization. All data came from Medicaid claims data and corresponding administrative records. Regression analyses showed that enrollment in MMC was significantly related to each of the three outcomes; MMC enrollees were more likely than the FFS group to see a PCP during the 1-year post-period and have high levels of continuity of care with a single PCP. However, FFS enrollees were more likely to maintain a relationship with their PCP providers from the pre-period through the post-period. Therefore, while more people in MMC than FFS visit a PCP each year, for people in MMC, it is often a new provider relationship, which can be problematic for people with disabilities. Additional training for PCPs, to prepare them for working with people with disabilities, and additional efforts to expand the MMC network of providers are needed.

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The Great Interstate Divergence: Partisan Bureaucracies in the Contemporary United States

Merriman

Pacewicz

2022

American Journal of Sociology

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Health services appraisal and the transition to Medicaid Managed Care from fee for service

Cited by 5 publications

References 49 publications

Impacts of an Integrated Medicaid Managed Care Program for Adults with Behavioral Health Conditions: The Experience of Illinois

Impacts of an Integrated Medicaid Managed Care Program for Adults with Behavioral Health Conditions: The Experience of Illinois

Utilization of and Relationships With Primary Care Providers During the Transition to Medicaid Managed Care

The Great Interstate Divergence: Partisan Bureaucracies in the Contemporary United States

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