Promoting Choice: Lessons from Managed Medicaid

Health Affairs

Volumn 17, Issue 5, 1998, Pages 165-174

  Fraser, Irene ^a   Chait, Elizabeth ^b   Brach, Cindy ^c  

^a AGENCY FOR HEALTHCARE RESEARCH AND QUALITY   (United States)

^b Health Systems Research Inc   (United States)

^c NONE

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; CONSUMER; HEALTH CARE POLICY; HEALTH INSURANCE; HUMAN; MEDICAID; ORGANIZATION AND MANAGEMENT; UNITED STATES;

CONSUMER PARTICIPATION; HEALTH POLICY; HUMANS; MANAGED CARE PROGRAMS; MEDICAID; UNITED STATES;

EID: 0032162025     PISSN: 02782715     EISSN: None     Source Type: Journal    
DOI: 10.1377/hlthaff.17.5.165     Document Type: Article

References (25)

1. Agency for Health Care Policy and Research, Consumer Survey Information in a Reforming Health Care System, AHCPR Pub. no. 95-0083 (Rockville, Md.: AHCPR, 1995); D.A. Gibbs, J.A. Sangl, and B. Burrus, "Consumer Perspectives on Information Needs for Health Plan Choice," Health Care Financing Review 18, no. 1 (1996): 55-74; J.H. Hibbard, S. Sofaer, and J.J. Jewett, "Condition-Specific Performance Information: Assessing Salience, Comprehension, and Approaches for Communicating Quality," Health Care Financing Review 18, no. 1 (1996): 95-110; J.J. Jewett and J.H Hibbard, "Comprehension of Quality Care Indicators: Differences among Privately Insured, Publicly Insured, and Uninsured," Health Care Financing Review 18, no. 1 (1996): 75-94; L.A. McCormack et al., "Consumer Information Development and Use," Health Care Financing Review 18, no. 1 (1996): 15-30; and J. McGee, S. Sofaer, and B. Kreling, Findings from Focus Groups for the National Committee for Quality Assurance (NCQA) Medicare and Medicaid Consumer Information Projects (Rockville, Md.: AHCPR, July 1996). For research on education and enrollment strategies, see S.I. Des Harnais, "Enrollment in and Disenrollment from Health Maintenance Organizations by Medicaid Recipients," Health Care Financing Review 6, no. 3 (1985): 39-50; L.A. McCormack et al., "Medicare Beneficiary Counseling Programs: What Are They and Do They Work?" Health Care Financing Review 18, no. 1 (1996): 127-140; and L.W. Morton, "Medicaid Enrollment Choice into Managed Care Plans," Medical Care Research and Review (June 1998): 211-238.
2. Agency for Health Care Policy and Research, Consumer Survey Information in a Reforming Health Care System, AHCPR Pub. no. 95-0083 (Rockville, Md.: AHCPR, 1995); D.A. Gibbs, J.A. Sangl, and B. Burrus, "Consumer Perspectives on Information Needs for Health Plan Choice," Health Care Financing Review 18, no. 1 (1996): 55-74; J.H. Hibbard, S. Sofaer, and J.J. Jewett, "Condition-Specific Performance Information: Assessing Salience, Comprehension, and Approaches for Communicating Quality," Health Care Financing Review 18, no. 1 (1996): 95-110; J.J. Jewett and J.H Hibbard, "Comprehension of Quality Care Indicators: Differences among Privately Insured, Publicly Insured, and Uninsured," Health Care Financing Review 18, no. 1 (1996): 75-94; L.A. McCormack et al., "Consumer Information Development and Use," Health Care Financing Review 18, no. 1 (1996): 15-30; and J. McGee, S. Sofaer, and B. Kreling, Findings from Focus Groups for the National Committee for Quality Assurance (NCQA) Medicare and Medicaid Consumer Information Projects (Rockville, Md.: AHCPR, July 1996). For research on education and enrollment strategies, see S.I. Des Harnais, "Enrollment in and Disenrollment from Health Maintenance Organizations by Medicaid Recipients," Health Care Financing Review 6, no. 3 (1985): 39-50; L.A. McCormack et al., "Medicare Beneficiary Counseling Programs: What Are They and Do They Work?" Health Care Financing Review 18, no. 1 (1996): 127-140; and L.W. Morton, "Medicaid Enrollment Choice into Managed Care Plans," Medical Care Research and Review (June 1998): 211-238.
3. Agency for Health Care Policy and Research, Consumer Survey Information in a Reforming Health Care System, AHCPR Pub. no. 95-0083 (Rockville, Md.: AHCPR, 1995); D.A. Gibbs, J.A. Sangl, and B. Burrus, "Consumer Perspectives on Information Needs for Health Plan Choice," Health Care Financing Review 18, no. 1 (1996): 55-74; J.H. Hibbard, S. Sofaer, and J.J. Jewett, "Condition-Specific Performance Information: Assessing Salience, Comprehension, and Approaches for Communicating Quality," Health Care Financing Review 18, no. 1 (1996): 95-110; J.J. Jewett and J.H Hibbard, "Comprehension of Quality Care Indicators: Differences among Privately Insured, Publicly Insured, and Uninsured," Health Care Financing Review 18, no. 1 (1996): 75-94; L.A. McCormack et al., "Consumer Information Development and Use," Health Care Financing Review 18, no. 1 (1996): 15-30; and J. McGee, S. Sofaer, and B. Kreling, Findings from Focus Groups for the National Committee for Quality Assurance (NCQA) Medicare and Medicaid Consumer Information Projects (Rockville, Md.: AHCPR, July 1996). For research on education and enrollment strategies, see S.I. Des Harnais, "Enrollment in and Disenrollment from Health Maintenance Organizations by Medicaid Recipients," Health Care Financing Review 6, no. 3 (1985): 39-50; L.A. McCormack et al., "Medicare Beneficiary Counseling Programs: What Are They and Do They Work?" Health Care Financing Review 18, no. 1 (1996): 127-140; and L.W. Morton, "Medicaid Enrollment Choice into Managed Care Plans," Medical Care Research and Review (June 1998): 211-238.
4. Agency for Health Care Policy and Research, Consumer Survey Information in a Reforming Health Care System, AHCPR Pub. no. 95-0083 (Rockville, Md.: AHCPR, 1995); D.A. Gibbs, J.A. Sangl, and B. Burrus, "Consumer Perspectives on Information Needs for Health Plan Choice," Health Care Financing Review 18, no. 1 (1996): 55-74; J.H. Hibbard, S. Sofaer, and J.J. Jewett, "Condition-Specific Performance Information: Assessing Salience, Comprehension, and Approaches for Communicating Quality," Health Care Financing Review 18, no. 1 (1996): 95-110; J.J. Jewett and J.H Hibbard, "Comprehension of Quality Care Indicators: Differences among Privately Insured, Publicly Insured, and Uninsured," Health Care Financing Review 18, no. 1 (1996): 75-94; L.A. McCormack et al., "Consumer Information Development and Use," Health Care Financing Review 18, no. 1 (1996): 15-30; and J. McGee, S. Sofaer, and B. Kreling, Findings from Focus Groups for the National Committee for Quality Assurance (NCQA) Medicare and Medicaid Consumer Information Projects (Rockville, Md.: AHCPR, July 1996). For research on education and enrollment strategies, see S.I. Des Harnais, "Enrollment in and Disenrollment from Health Maintenance Organizations by Medicaid Recipients," Health Care Financing Review 6, no. 3 (1985): 39-50; L.A. McCormack et al., "Medicare Beneficiary Counseling Programs: What Are They and Do They Work?" Health Care Financing Review 18, no. 1 (1996): 127-140; and L.W. Morton, "Medicaid Enrollment Choice into Managed Care Plans," Medical Care Research and Review (June 1998): 211-238.
5. Agency for Health Care Policy and Research, Consumer Survey Information in a Reforming Health Care System, AHCPR Pub. no. 95-0083 (Rockville, Md.: AHCPR, 1995); D.A. Gibbs, J.A. Sangl, and B. Burrus, "Consumer Perspectives on Information Needs for Health Plan Choice," Health Care Financing Review 18, no. 1 (1996): 55-74; J.H. Hibbard, S. Sofaer, and J.J. Jewett, "Condition-Specific Performance Information: Assessing Salience, Comprehension, and Approaches for Communicating Quality," Health Care Financing Review 18, no. 1 (1996): 95-110; J.J. Jewett and J.H Hibbard, "Comprehension of Quality Care Indicators: Differences among Privately Insured, Publicly Insured, and Uninsured," Health Care Financing Review 18, no. 1 (1996): 75-94; L.A. McCormack et al., "Consumer Information Development and Use," Health Care Financing Review 18, no. 1 (1996): 15-30; and J. McGee, S. Sofaer, and B. Kreling, Findings from Focus Groups for the National Committee for Quality Assurance (NCQA) Medicare and Medicaid Consumer Information Projects (Rockville, Md.: AHCPR, July 1996). For research on education and enrollment strategies, see S.I. Des Harnais, "Enrollment in and Disenrollment from Health Maintenance Organizations by Medicaid Recipients," Health Care Financing Review 6, no. 3 (1985): 39-50; L.A. McCormack et al., "Medicare Beneficiary Counseling Programs: What Are They and Do They Work?" Health Care Financing Review 18, no. 1 (1996): 127-140; and L.W. Morton, "Medicaid Enrollment Choice into Managed Care Plans," Medical Care Research and Review (June 1998): 211-238.
6. Agency for Health Care Policy and Research, Consumer Survey Information in a Reforming Health Care System, AHCPR Pub. no. 95-0083 (Rockville, Md.: AHCPR, 1995); D.A. Gibbs, J.A. Sangl, and B. Burrus, "Consumer Perspectives on Information Needs for Health Plan Choice," Health Care Financing Review 18, no. 1 (1996): 55-74; J.H. Hibbard, S. Sofaer, and J.J. Jewett, "Condition-Specific Performance Information: Assessing Salience, Comprehension, and Approaches for Communicating Quality," Health Care Financing Review 18, no. 1 (1996): 95-110; J.J. Jewett and J.H Hibbard, "Comprehension of Quality Care Indicators: Differences among Privately Insured, Publicly Insured, and Uninsured," Health Care Financing Review 18, no. 1 (1996): 75-94; L.A. McCormack et al., "Consumer Information Development and Use," Health Care Financing Review 18, no. 1 (1996): 15-30; and J. McGee, S. Sofaer, and B. Kreling, Findings from Focus Groups for the National Committee for Quality Assurance (NCQA) Medicare and Medicaid Consumer Information Projects (Rockville, Md.: AHCPR, July 1996). For research on education and enrollment strategies, see S.I. Des Harnais, "Enrollment in and Disenrollment from Health Maintenance Organizations by Medicaid Recipients," Health Care Financing Review 6, no. 3 (1985): 39-50; L.A. McCormack et al., "Medicare Beneficiary Counseling Programs: What Are They and Do They Work?" Health Care Financing Review 18, no. 1 (1996): 127-140; and L.W. Morton, "Medicaid Enrollment Choice into Managed Care Plans," Medical Care Research and Review (June 1998): 211-238.
7. Agency for Health Care Policy and Research, Consumer Survey Information in a Reforming Health Care System, AHCPR Pub. no. 95-0083 (Rockville, Md.: AHCPR, 1995); D.A. Gibbs, J.A. Sangl, and B. Burrus, "Consumer Perspectives on Information Needs for Health Plan Choice," Health Care Financing Review 18, no. 1 (1996): 55-74; J.H. Hibbard, S. Sofaer, and J.J. Jewett, "Condition-Specific Performance Information: Assessing Salience, Comprehension, and Approaches for Communicating Quality," Health Care Financing Review 18, no. 1 (1996): 95-110; J.J. Jewett and J.H Hibbard, "Comprehension of Quality Care Indicators: Differences among Privately Insured, Publicly Insured, and Uninsured," Health Care Financing Review 18, no. 1 (1996): 75-94; L.A. McCormack et al., "Consumer Information Development and Use," Health Care Financing Review 18, no. 1 (1996): 15-30; and J. McGee, S. Sofaer, and B. Kreling, Findings from Focus Groups for the National Committee for Quality Assurance (NCQA) Medicare and Medicaid Consumer Information Projects (Rockville, Md.: AHCPR, July 1996). For research on education and enrollment strategies, see S.I. Des Harnais, "Enrollment in and Disenrollment from Health Maintenance Organizations by Medicaid Recipients," Health Care Financing Review 6, no. 3 (1985): 39-50; L.A. McCormack et al., "Medicare Beneficiary Counseling Programs: What Are They and Do They Work?" Health Care Financing Review 18, no. 1 (1996): 127-140; and L.W. Morton, "Medicaid Enrollment Choice into Managed Care Plans," Medical Care Research and Review (June 1998): 211-238.
8. Agency for Health Care Policy and Research, Consumer Survey Information in a Reforming Health Care System, AHCPR Pub. no. 95-0083 (Rockville, Md.: AHCPR, 1995); D.A. Gibbs, J.A. Sangl, and B. Burrus, "Consumer Perspectives on Information Needs for Health Plan Choice," Health Care Financing Review 18, no. 1 (1996): 55-74; J.H. Hibbard, S. Sofaer, and J.J. Jewett, "Condition-Specific Performance Information: Assessing Salience, Comprehension, and Approaches for Communicating Quality," Health Care Financing Review 18, no. 1 (1996): 95-110; J.J. Jewett and J.H Hibbard, "Comprehension of Quality Care Indicators: Differences among Privately Insured, Publicly Insured, and Uninsured," Health Care Financing Review 18, no. 1 (1996): 75-94; L.A. McCormack et al., "Consumer Information Development and Use," Health Care Financing Review 18, no. 1 (1996): 15-30; and J. McGee, S. Sofaer, and B. Kreling, Findings from Focus Groups for the National Committee for Quality Assurance (NCQA) Medicare and Medicaid Consumer Information Projects (Rockville, Md.: AHCPR, July 1996). For research on education and enrollment strategies, see S.I. Des Harnais, "Enrollment in and Disenrollment from Health Maintenance Organizations by Medicaid Recipients," Health Care Financing Review 6, no. 3 (1985): 39-50; L.A. McCormack et al., "Medicare Beneficiary Counseling Programs: What Are They and Do They Work?" Health Care Financing Review 18, no. 1 (1996): 127-140; and L.W. Morton, "Medicaid Enrollment Choice into Managed Care Plans," Medical Care Research and Review (June 1998): 211-238.
9. Agency for Health Care Policy and Research, Consumer Survey Information in a Reforming Health Care System, AHCPR Pub. no. 95-0083 (Rockville, Md.: AHCPR, 1995); D.A. Gibbs, J.A. Sangl, and B. Burrus, "Consumer Perspectives on Information Needs for Health Plan Choice," Health Care Financing Review 18, no. 1 (1996): 55-74; J.H. Hibbard, S. Sofaer, and J.J. Jewett, "Condition-Specific Performance Information: Assessing Salience, Comprehension, and Approaches for Communicating Quality," Health Care Financing Review 18, no. 1 (1996): 95-110; J.J. Jewett and J.H Hibbard, "Comprehension of Quality Care Indicators: Differences among Privately Insured, Publicly Insured, and Uninsured," Health Care Financing Review 18, no. 1 (1996): 75-94; L.A. McCormack et al., "Consumer Information Development and Use," Health Care Financing Review 18, no. 1 (1996): 15-30; and J. McGee, S. Sofaer, and B. Kreling, Findings from Focus Groups for the National Committee for Quality Assurance (NCQA) Medicare and Medicaid Consumer Information Projects (Rockville, Md.: AHCPR, July 1996). For research on education and enrollment strategies, see S.I. Des Harnais, "Enrollment in and Disenrollment from Health Maintenance Organizations by Medicaid Recipients," Health Care Financing Review 6, no. 3 (1985): 39-50; L.A. McCormack et al., "Medicare Beneficiary Counseling Programs: What Are They and Do They Work?" Health Care Financing Review 18, no. 1 (1996): 127-140; and L.W. Morton, "Medicaid Enrollment Choice into Managed Care Plans," Medical Care Research and Review (June 1998): 211-238.
10. See J. Meyer, L. Rybowski, and R. Eichler, Theory and Reality of Value-Based Purchasing: Lessons from the Innovators, AHCPR Pub. no. 98-0004 (Rockville, Md.: AHCPR, 1997).
11. K. Davis et al., "Choice Matters: Enrollees' Views of Their Health Plans," Health Affairs (Summer 1995): 99-112; and J. Schmittdiel et al., "Choice of a Personal Physician and Patient Satisfaction in a Health Maintenance Organization," Journal of the American Medical Association 278, no. 19 (1997): 1596-1599.
12. K. Davis et al., "Choice Matters: Enrollees' Views of Their Health Plans," Health Affairs (Summer 1995): 99-112; and J. Schmittdiel et al., "Choice of a Personal Physician and Patient Satisfaction in a Health Maintenance Organization," Journal of the American Medical Association 278, no. 19 (1997): 1596-1599.
13. Kaiser Family Foundation, Agency for Health Care Policy and Research, and Princeton Survey Research Associates, Americans as Health Care Consumers: The Role of Quality Information (Menlo Park, Calif.: Kaiser Family Foundation, October 1996); F.A. Garfinkel et al., "Choice of Payment Plan in the Medicare Capitation Demonstrations," Medical Care 24, no. 7 (1986): 628-640; K.L Grazier et al., "Factors Affecting Choice of Health Care Plans," Health Services Research 20, no. 6 (1986): 659-682; R.E. Hurley, B.J. Gage, and D. Freund, "Rollover Effects in Gatekeeper Programs: Cushioning the Impact of Restricted Choice," Inquiry 28, no. 4 (1991): 375-384; and F. Sainfort and B.C. Booske, "Role of Information in Consumer Selection of Health Plans," Health Care Financing Review 18, no. 1 (1996): 31-54.
14. Kaiser Family Foundation, Agency for Health Care Policy and Research, and Princeton Survey Research Associates, Americans as Health Care Consumers: The Role of Quality Information (Menlo Park, Calif.: Kaiser Family Foundation, October 1996); F.A. Garfinkel et al., "Choice of Payment Plan in the Medicare Capitation Demonstrations," Medical Care 24, no. 7 (1986): 628-640; K.L Grazier et al., "Factors Affecting Choice of Health Care Plans," Health Services Research 20, no. 6 (1986): 659-682; R.E. Hurley, B.J. Gage, and D. Freund, "Rollover Effects in Gatekeeper Programs: Cushioning the Impact of Restricted Choice," Inquiry 28, no. 4 (1991): 375-384; and F. Sainfort and B.C. Booske, "Role of Information in Consumer Selection of Health Plans," Health Care Financing Review 18, no. 1 (1996): 31-54.
15. Kaiser Family Foundation, Agency for Health Care Policy and Research, and Princeton Survey Research Associates, Americans as Health Care Consumers: The Role of Quality Information (Menlo Park, Calif.: Kaiser Family Foundation, October 1996); F.A. Garfinkel et al., "Choice of Payment Plan in the Medicare Capitation Demonstrations," Medical Care 24, no. 7 (1986): 628-640; K.L Grazier et al., "Factors Affecting Choice of Health Care Plans," Health Services Research 20, no. 6 (1986): 659-682; R.E. Hurley, B.J. Gage, and D. Freund, "Rollover Effects in Gatekeeper Programs: Cushioning the Impact of Restricted Choice," Inquiry 28, no. 4 (1991): 375-384; and F. Sainfort and B.C. Booske, "Role of Information in Consumer Selection of Health Plans," Health Care Financing Review 18, no. 1 (1996): 31-54.
16. Kaiser Family Foundation, Agency for Health Care Policy and Research, and Princeton Survey Research Associates, Americans as Health Care Consumers: The Role of Quality Information (Menlo Park, Calif.: Kaiser Family Foundation, October 1996); F.A. Garfinkel et al., "Choice of Payment Plan in the Medicare Capitation Demonstrations," Medical Care 24, no. 7 (1986): 628-640; K.L Grazier et al., "Factors Affecting Choice of Health Care Plans," Health Services Research 20, no. 6 (1986): 659-682; R.E. Hurley, B.J. Gage, and D. Freund, "Rollover Effects in Gatekeeper Programs: Cushioning the Impact of Restricted Choice," Inquiry 28, no. 4 (1991): 375-384; and F. Sainfort and B.C. Booske, "Role of Information in Consumer Selection of Health Plans," Health Care Financing Review 18, no. 1 (1996): 31-54.
17. Kaiser Family Foundation, Agency for Health Care Policy and Research, and Princeton Survey Research Associates, Americans as Health Care Consumers: The Role of Quality Information (Menlo Park, Calif.: Kaiser Family Foundation, October 1996); F.A. Garfinkel et al., "Choice of Payment Plan in the Medicare Capitation Demonstrations," Medical Care 24, no. 7 (1986): 628-640; K.L Grazier et al., "Factors Affecting Choice of Health Care Plans," Health Services Research 20, no. 6 (1986): 659-682; R.E. Hurley, B.J. Gage, and D. Freund, "Rollover Effects in Gatekeeper Programs: Cushioning the Impact of Restricted Choice," Inquiry 28, no. 4 (1991): 375-384; and F. Sainfort and B.C. Booske, "Role of Information in Consumer Selection of Health Plans," Health Care Financing Review 18, no. 1 (1996): 31-54.
18. Many states began their experiments with Medicaid managed care under the freedom-of-choice waiver, Section 1915(b) of the Social Security Act, which allows states to restrict a recipient's choice of providers. A waiver authority used with some frequency in recent years is the research and demonstration waiver (Section 1115), which allows states to waive many Medicaid requirements, including freedom of choice, in order to test program improvements or investigate an area of interest to HCFA.
19. U.S. General Accounting Office, Better Controls Needed for Health Maintenance Organizations under Medicaid in California, Pub. no. B-164031 (Washington: GAO, 1974).
20. The observed increase in marketing restrictions is part of a national trend. A 1996 survey found that thirty-six of the forty-five responding states restricted marketing by Medicaid managed care plans; one-third of them developed the restrictions in the past year. Integrated Healthcare Services, Managed Medicaid Marketing and Enrollment Survey (Princeton, N.J.: Integrated Healthcare Services, May 1997).
21. This also parallels the national trend. Twenty-six of the forty states that offer managed care plan choices established an enrollment counseling program by contracting with an independent broker by mid-1997. M.S. Kenesson, Medicaid Managed Care Enrollment Study (Princeton, N.J.: Center for Health Care Strategies, December 1997).
22. Such problems are not unique to Medicaid. In recent surveys conducted by Harvard University and Louis Harris and Associates, the top problem with managed care identified by physicians was the movement of patients in and out of the practice because of changes in their insurance coverage. See K. Donelan et al., "The New Medical Marketplace: Physicians' Views," Health Affairs (September/October 1996): 139-148.
23. National Committee for Quality Assurance, Health Plan Employer Data and Information Set (HEDIS) 3.0 (Washington: NCQA, 1998); and Agency for Health Care Policy and Research, Consumer Assessments of Health Plans Study (CAHPS), AHCPR Pub. no. 96-RO68 (Rockville, Md.: AHCPR, 1996).
24. National Committee for Quality Assurance, Health Plan Employer Data and Information Set (HEDIS) 3.0 (Washington: NCQA, 1998); and Agency for Health Care Policy and Research, Consumer Assessments of Health Plans Study (CAHPS), AHCPR Pub. no. 96-RO68 (Rockville, Md.: AHCPR, 1996).
25. P. Hanes et al., Oregon Consumer Scorecard Project Final Report, AHCPR Contract no. 282-93-0036 (Rockville, Md.: AHCPR, 1996).