Racial and Ethnic Differences in Receipt of Primary Care Services Between Medicaid Fee-for-Service and Managed Care Plans

Seligman, Hilary K.; Chattopadhyay, Arpita; Vittinghoff, Eric; Bindman, Andrew B.

doi:10.1097/01.jac.0000278986.18428.12

Cited by 9 publications

(4 citation statements)

References 24 publications

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“…The quality of care for elderly Medicare beneficiaries in managed-care plans has improved over time, and racial disparities for beneficiaries of these plans have declined substantially for several measures of quality in cancer screening, diabetes care, and prescription of cardiovascular drugs (24). While never studied specifically in older adults, the increasing use of Medicaid managed care plans for adults <65 years of age has been shown to reduce or eliminate racial/ethnic disparities in younger Medicaid beneficiaries’ access to care (25, 26). …”

Section: Discussionmentioning

confidence: 99%

Race, Ethnicity, Health Insurance, and Mortality in Older Survivors of Critical Illness

Baldwin

Sell

Heyden

et al. 2017

Critical Care Medicine

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Objective To determine whether minority race or ethnicity are associated with mortality and mediated by health insurance coverage among older (age ≥65 years) survivors of critical illness. Design A retrospective cohort study. Setting Two New York City academic medical centers. Patients A total of 1,947 consecutive white (1,107), black (361), and Hispanic (479) older adults who had their first medical-ICU admission from 2006 through 2009 and survived to hospital discharge. Interventions None. Measurements and Main Results We obtained demographic, insurance, and clinical data from electronic health records, determined each patient’s neighborhood-level socioeconomic data from 2010 US Census tract data, and determined death dates using the Social Security Death Index. Subjects had a mean (SD) age of 79 (8.6) years and median (IQR) follow-up time of 1.6 (0.4–3.0) years. Blacks and Hispanics had similar mortality rates compared to whites (adjusted-hazard ratio [HR] 0.92, 95% CI 0.76–1.11 and adjusted-HR 0.92, 95% CI 0.76–1.12, respectively). Compared to those with commercial insurance and Medicare, higher mortality rates were observed for those with Medicare only (adjusted-HR 1.43, 95% CI 1.03–1.98) and Medicaid (adjusted-HR 1.30, 95% CI 1.10–1.52). Medicaid recipients who were the oldest ICU survivors (age >82 years), survivors of mechanical ventilation, and discharged to skilled-care facilities had the highest mortality rates (p-for-interaction 0.08, 0.03, and 0.17, respectively). Conclusions Mortality after critical illness among older adults varies by insurance coverage, but not by race or ethnicity. Those with federal or state insurance coverage only had higher mortality rates than those with additional commercial insurance.

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Section: Discussionmentioning

confidence: 99%

Race, Ethnicity, Health Insurance, and Mortality in Older Survivors of Critical Illness

Baldwin

Sell

Heyden

et al. 2017

Critical Care Medicine

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“…However, the results from previous studies have been inconsistent. Since 2000, five studies have examined whether Medicaid managed care affects preventable hospitalization patterns [16,20-23], but none of them analyzed the Medicaid population in Florida. Previous studies did not demonstrate a clear benefit of Medicaid managed care [16,20].…”

Section: Introductionmentioning

confidence: 99%

The association between managed care enrollments and potentially preventable hospitalization among adult Medicaid recipients in Florida

Lee

2014

BMC Health Serv Res

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BackgroundThe intent of adopting managed care plans is to improve access to health care services while containing costs. To date, there have been a number of studies that examine the relationship between managed care and access to health care. However, the results from previous studies have been inconsistent. Specifically, previous studies did not demonstrate a clear benefit of Medicaid managed care. In this study we have examine whether Medicaid managed care is associated with the probabilities of preventable hospitalizations. This study also analyzes the spillover effect of Medicaid managed care into Medicaid patients in traditional FFS plans and the interaction effects of other patient- and county-level variables on preventable hospitalizations.MethodsThe study included 254,321 Medicaid patients who were admitted to short-term general hospital in the 67 counties in Florida. Using 2008 hospital inpatient discharge data for working-age adult Medicaid enrollees (18-64 years) in Florida, we conduct multivariate logistic regression analyses to identify possible factors associated with preventable hospitalizations. The first model includes patient- and county-level variables. Then, we add interaction terms between Medicaid HMO and other variables such as race, rurality, market-level factors, and resource for primary care.ResultsThe results show that Medicaid HMO patients are more likely to be hospitalized for ambulatory care sensitive conditions (ACSCs) (OR = 1.30; CI = 1.21, 1.40). We also find that market structure (i.e., competition) is significantly associated with preventable hospitalizations. However, our study does not support that there are spillover effects of Medicaid managed care on preventable hospitalizations for other Medicaid recipients. We find that interactions between Medicaid managed care and race, rurality and market structure are significant.ConclusionsThe results of our study show that the Medicaid managed care program in Florida was associated with an increase in potentially preventable hospitalizations for Medicaid enrollees. The results suggest that lower capitation rate has been associated with a greater likelihood of preventable hospitalizations for Medicaid managed care patients. Our findings also indicate that increased competition in the Medicaid managed care market has no clear benefit in Medicaid managed care patients.

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“…Regarding our interest in questions about individuallevel impacts, some MMC programs led to improved or unchanged access for Medicaid recipients, while other programs manifested enduring access barriers (Baker and Afendulis 2005;Berman, Armon, and Todd 2005;Fairbrother et al 2005;Sommers 2005;Seligman et al 2007); MMC exerted no consistent effects on access for the uninsured (Haberer, Garrett, and Baker 2005). Utilization under MMC proved inconsistent, even involving services targeted for reduction such as emergency department visits (Alessandrini et al 2001b;Garrett, Davidoff, and Yemane 2003;Davidoff et al 2007).…”

Section: Background On MMCmentioning

confidence: 99%

Multimethod Evaluation of Health Policy Change: An Application to Medicaid Managed Care in a Rural State

Waitzkin

Schillaci

Willging

2008

Health Services Research

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Objective. To answer questions about the impacts of Medicaid managed care (MMC) at the individual, organizational/community, and population levels of analysis. Data Sources/Study Setting. Multimethod approach to study MMC in New Mexico, a rural state with challenging access barriers. Study Design. Individual level: surveys to assess barriers to care, access, utilization, and satisfaction. Organizational/community level: ethnography to determine changes experienced by safety net institutions and local communities. Population level: analysis of secondary databases to examine trends in preventable adverse sentinel events. Data Collection/Extraction Methods. Survey: multivariate statistical methods, including factor analysis and logistic regression. Ethnography: iterative coding and triangulation to assess documents, field observations, and in-depth interviews. Secondary databases: plots of sentinel events over time. Principal Findings. The survey component revealed no consistent changes after MMC, relatively favorable experiences for Medicaid patients, and persisting access barriers for the uninsured. In the ethnographic component, safety net institutions experienced increased workload and financial stress; mental health services declined sharply. Immunization rate, as an important sentinel event, deteriorated. Conclusions. MMC exerted greater effects on safety net providers than on individuals and did not address problems of the uninsured. A multimethod approach can facilitate evaluation of change in health policy.Key Words. Medicaid managed care, safety net, multimethod research, access, ethnographyIn health services research, the problem of how to evaluate the results of policy change has remained challenging (Evaluation Gap Working Group 2006

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Racial and Ethnic Differences in Receipt of Primary Care Services Between Medicaid Fee-for-Service and Managed Care Plans

Cited by 9 publications

References 24 publications

Race, Ethnicity, Health Insurance, and Mortality in Older Survivors of Critical Illness

Race, Ethnicity, Health Insurance, and Mortality in Older Survivors of Critical Illness

The association between managed care enrollments and potentially preventable hospitalization among adult Medicaid recipients in Florida

Multimethod Evaluation of Health Policy Change: An Application to Medicaid Managed Care in a Rural State

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