In Medicaid Managed Care Networks, Care Is Highly Concentrated Among A Small Percentage Of Physicians

Ludomirsky, Avital B; Schpero, William L.; Wallace, Jacob; Lollo, Anthony; Bernheim, Susannah M.; Ross, Joseph S.; Ndumele, Chima D.

doi:10.1377/hlthaff.2021.01747

Cited by 29 publications

(44 citation statements)

References 13 publications

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“…These transitions, although potentially not as disruptive as switching between or among private and Marketplace plans with potential changes in deductibles and/or copayment structures in addition to changes in the provider network, may still have implications for access to care. Provider networks have been shown to vary substantially across Medicaid managed care plans, 20 specifically for obstetric practitioners. 19 Although less frequent, we found that perinatal insurance transitions were also common among individuals with private insurance.…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…We are not aware of any studies examining perinatal transitions between Medicaid and Medicaid managed care despite evidence that provider networks, including for obstetric care, vary substantially across and within these Medicaid plan types. 19,20 To better understand the frequency and types of health insurance transitions, we examined insurance transitions for birthing individuals with continuous insurance before, during, and after pregnancy. We identified transitions at each stage of the perinatal period, categorized these transitions by type of insurance transition, and examined factors associated with an insurance transition.…”

Section: Introductionmentioning

confidence: 99%

“…One study examined Marketplace coverage during the perinatal period and found that only one-third of individuals with Marketplace coverage had it continuously from conception through post partum, underscoring the importance of understanding coverage patterns by specific insurance types. We are not aware of any studies examining perinatal transitions between Medicaid and Medicaid managed care despite evidence that provider networks, including for obstetric care, vary substantially across and within these Medicaid plan types …”

Section: Introductionmentioning

confidence: 99%

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Transitions in Health Insurance During the Perinatal Period Among Patients With Continuous Insurance Coverage

2022

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ImportanceAlthough health insurance continuity is important during the perinatal period to improve birth outcomes and reduce maternal morbidity and mortality, insurance disruptions are common. However, little is known about insurance transitions among insurance types for individuals who remained insured during the perinatal period.ObjectiveTo examine insurance transitions for birthing individuals with continuous insurance, including those with Medicaid and Medicaid managed care coverage, before, during, and after pregnancy.Design, Setting, and ParticipantsThis cohort study used January 1, 2014 to December 31, 2018 data from the Massachusetts All-Payer Claims Database. The sample included deliveries from January 1, 2015, to December 31, 2017, to birthing individuals aged 18 to 44 years old with continuous insurance for 12 months before and after delivery. Data were analyzed from November 9, 2021, to September 2, 2022.ExposureInsurance type at delivery.Main Outcomes and MeasuresThe primary outcome was a binary indicator of any transition in insurance type from 12 months before and/or after delivery. The secondary outcomes were measures of any predelivery transition (12 months before delivery month) and any transition during the postpartum period (delivery month to 12 months post partum). Multivariate logit regression models were used to analyze the association of an insurance transition in the perinatal period with insurance type in the delivery month, controlling for age and socioeconomic status based on a 5-digit zip code.ResultsThe analytic sample included 97 335 deliveries (mean [SD] maternal age at delivery, 30.4 [5.5] years). Of these deliveries, 23.4% (22 794) were insured by Medicaid and 28.1% (27 347) by Medicaid managed care in the delivery month. A total of 37.1% of the sample (36 127) had at least 1 insurance transition during the 12 months before and/or after delivery. In regression-adjusted analyses, those individuals covered by Medicaid and Medicaid managed care at delivery were 47.0 (95% CI, 46.3-47.7) percentage points and 50.1 (95% CI, 49.4-50.8) percentage points, respectively, more likely to have an insurance transition than those covered by private insurance. Those covered by Marketplace plans at delivery had a 33.1% (95% CI, 31.4%-34.8%) regression-adjusted predicted probability of having a postpartum insurance transition.Conclusions and RelevanceResults of this study showed that insurance transitions during the perinatal period occurred for more than 1 in 3 birthing individuals with continuous insurance and were more common among those with Medicaid or Medicaid managed care at delivery. Further research is needed to examine the role of insurance transitions in health care use and outcomes during the perinatal period.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Transitions in Health Insurance During the Perinatal Period Among Patients With Continuous Insurance Coverage

2022

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“…This is not surprising, given the low fee-for-service Medicaid reimbursement and narrow networks within Medicaid-managed care. 7 Numerous other studies have also shown a connection between socioeconomics and TBI care. Uninsured patients with TBI are less likely to be admitted compared with their commercially insured counterparts.…”

mentioning

confidence: 95%