Medicaid Managed Care: Lessons from Five States

Health Affairs

Volumn 15, Issue 3, 1996, Pages 153-166

  Gold, Marsha ^a   Sparer, Michael ^b   Chu, Karyen ^c  

^a MATHEMATICA POLICY RESEARCH   (United States)

^b Och Spine at New York Presbyterian Hospitals

^c MPR ^*

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; COST; ECONOMICS; FINANCIAL MANAGEMENT; HEALTH CARE COST; HEALTH CARE DELIVERY; HEALTH INSURANCE; HEALTH MAINTENANCE ORGANIZATION; HUMAN; MANAGEMENT; MEDICAID; ORGANIZATION; ORGANIZATION AND MANAGEMENT; PATIENT; UNITED STATES; UTILIZATION REVIEW;

CALIFORNIA; COST SHARING; FINANCING, ORGANIZED; HEALTH CARE COSTS; HEALTH MAINTENANCE ORGANIZATIONS; HEALTH SERVICES ACCESSIBILITY; HUMANS; MANAGED CARE PROGRAMS; MARKETING OF HEALTH SERVICES; MEDICAID; MEDICALLY UNINSURED; MINNESOTA; NEW YORK; OREGON; ORGANIZATIONAL OBJECTIVES; POLICY MAKING; TENNESSEE; UNITED STATES;

EID: 0040173492     PISSN: 02782715     EISSN: None     Source Type: Journal    
DOI: 10.1377/hlthaff.15.3.153     Document Type: Article

References (22)

1. Health Care Financing Administration, Office of Managed Care, Medicaid Managed Care Enrollment Report, U.S. Department of Health and Human Services Summary Statistics (Washington: DHHS, 30 June 1994).
2. D. Rowland and K. Hanson, "Medicaid: Moving to Managed Care," Health Affairs (Fall 1996). 150-152.
3. U.S. General Accounting Office, Medicaid: States Turn to Managed Care to Improve Access and Control Costs, GAO/HRD 93-86 (Washington: GAO, March 1993).
4. California and New York are large states where initiatives are being phased in through collaboration with localities. We spent more time in these states (five days) and focused more on specific markets - Sacramento, Los Angeles, and Orange Counties in California and New York City and Albany/Rensselaer in New York.
5. M. Gold et al., "Behind the Curve: A Critical Assessment of How Little Is Known about Arrangements between Managed Care Plans and Physicians," Medical Care Research and Review (September 1995): 307-341.
6. J. Holahan et al., "Insuring the Poor through Section 1115 Medicaid Waivers," Health Affairs (Spring 1995): 200-217.
7. M. Gold, K. Chu, and B. Lyons, Managed Care and Low-Income Populations: A Case Study of Managed Care in Oregon (Report of The Henry J. Kaiser Family Foundation and The Commonwealth Fund, Washington, D.C., July 1995); M. Gold, H. Frazer, and C. Schoen, Managed Care and Low-Income Populations: A Case Study of Managed Care in Tennessee (Report of The Henry J. Kaiser Family Foundation and The Commonwealth Fund, Washington, D.C., July 1995); M. Sparer and K. Chu, Managed Care and Low-Income Populations: A Case Study of Managed Care in New York (forthcoming); M. Sparer, M. Ellwood, and C. Schoen, Managed Care and Low-Income Populations: A Case Study of Managed Care in Minnesota (Report of The Henry J. Kaiser Family Foundation and The Commonwealth Fund, November 1995); and M. Sparer, M. Gold, and L. Simon, Managed Care and Low-Income Populations: A Case Study of Managed Care in California (Report of The Henry J. Kaiser Family Foundation and The Commonwealth Fund, May 1996).
8. M. Gold, K. Chu, and B. Lyons, Managed Care and Low-Income Populations: A Case Study of Managed Care in Oregon (Report of The Henry J. Kaiser Family Foundation and The Commonwealth Fund, Washington, D.C., July 1995); M. Gold, H. Frazer, and C. Schoen, Managed Care and Low-Income Populations: A Case Study of Managed Care in Tennessee (Report of The Henry J. Kaiser Family Foundation and The Commonwealth Fund, Washington, D.C., July 1995); M. Sparer and K. Chu, Managed Care and Low-Income Populations: A Case Study of Managed Care in New York (forthcoming); M. Sparer, M. Ellwood, and C. Schoen, Managed Care and Low-Income Populations: A Case Study of Managed Care in Minnesota (Report of The Henry J. Kaiser Family Foundation and The Commonwealth Fund, November 1995); and M. Sparer, M. Gold, and L. Simon, Managed Care and Low-Income Populations: A Case Study of Managed Care in California (Report of The Henry J. Kaiser Family Foundation and The Commonwealth Fund, May 1996).
9. M. Gold, K. Chu, and B. Lyons, Managed Care and Low-Income Populations: A Case Study of Managed Care in Oregon (Report of The Henry J. Kaiser Family Foundation and The Commonwealth Fund, Washington, D.C., July 1995); M. Gold, H. Frazer, and C. Schoen, Managed Care and Low-Income Populations: A Case Study of Managed Care in Tennessee (Report of The Henry J. Kaiser Family Foundation and The Commonwealth Fund, Washington, D.C., July 1995); M. Sparer and K. Chu, Managed Care and Low-Income Populations: A Case Study of Managed Care in New York (forthcoming); M. Sparer, M. Ellwood, and C. Schoen, Managed Care and Low-Income Populations: A Case Study of Managed Care in Minnesota (Report of The Henry J. Kaiser Family Foundation and The Commonwealth Fund, November 1995); and M. Sparer, M. Gold, and L. Simon, Managed Care and Low-Income Populations: A Case Study of Managed Care in California (Report of The Henry J. Kaiser Family Foundation and The Commonwealth Fund, May 1996).
10. M. Gold, K. Chu, and B. Lyons, Managed Care and Low-Income Populations: A Case Study of Managed Care in Oregon (Report of The Henry J. Kaiser Family Foundation and The Commonwealth Fund, Washington, D.C., July 1995); M. Gold, H. Frazer, and C. Schoen, Managed Care and Low-Income Populations: A Case Study of Managed Care in Tennessee (Report of The Henry J. Kaiser Family Foundation and The Commonwealth Fund, Washington, D.C., July 1995); M. Sparer and K. Chu, Managed Care and Low-Income Populations: A Case Study of Managed Care in New York (forthcoming); M. Sparer, M. Ellwood, and C. Schoen, Managed Care and Low-Income Populations: A Case Study of Managed Care in Minnesota (Report of The Henry J. Kaiser Family Foundation and The Commonwealth Fund, November 1995); and M. Sparer, M. Gold, and L. Simon, Managed Care and Low-Income Populations: A Case Study of Managed Care in California (Report of The Henry J. Kaiser Family Foundation and The Commonwealth Fund, May 1996).
11. M. Gold, K. Chu, and B. Lyons, Managed Care and Low-Income Populations: A Case Study of Managed Care in Oregon (Report of The Henry J. Kaiser Family Foundation and The Commonwealth Fund, Washington, D.C., July 1995); M. Gold, H. Frazer, and C. Schoen, Managed Care and Low-Income Populations: A Case Study of Managed Care in Tennessee (Report of The Henry J. Kaiser Family Foundation and The Commonwealth Fund, Washington, D.C., July 1995); M. Sparer and K. Chu, Managed Care and Low-Income Populations: A Case Study of Managed Care in New York (forthcoming); M. Sparer, M. Ellwood, and C. Schoen, Managed Care and Low-Income Populations: A Case Study of Managed Care in Minnesota (Report of The Henry J. Kaiser Family Foundation and The Commonwealth Fund, November 1995); and M. Sparer, M. Gold, and L. Simon, Managed Care and Low-Income Populations: A Case Study of Managed Care in California (Report of The Henry J. Kaiser Family Foundation and The Commonwealth Fund, May 1996).
12. When MinnesotaCare converts to managed care, they plan to have a mail-in selection process because that is how the enrollment process is carried out. Some are concerned that this could lead to problems.
13. GAO, Medicaid: States Turn to Managed Care.
14. R. Moffitt and B. Wolfe, The Effect of the Medicaid Program on Welfare Participation in Labor Supply," Review of Economics and Statistics (November 1992): 615-626.
15. B. Snyder and E. Cromer, "TennCare Faces Rehab," Nashville Banner, 27 January 1995, Al, Al6.
16. Since our visit, the state has attempted to address the issue by consolidating state commercial and Medicaid managed care oversight in a newly created Office of Managed Care within the state Department of Health.
17. Physician Payment Review Commission, "Risk Adjustment," in Annual Report to Congress, 1994 (Washington: PPRC, 1994), 135-158.
18. This estimate is for initial capitation rates once the "withhold" is considered. The withhold reflects on offset held in reserve by the state to protect against losses.
19. To some extent, this reflects the low participation rates of some specialists, such as orthopedists, who were said to be boycotting the program, and general shortages of physicians, especially in inner-city and rural areas.
20. This plan had historically capitated its primary care providers, many of which were community health centers that viewed the capitation rates as considerably better than they could obtain through other plans paying fee-for-service. This plan also puts a priority on expediting payment to capitated providers, especially those whose circumstances made cash flow more critical.
21. W.F. Fox and W. Lyons, "A Survey to Determine Insurance Status of Tennessee Residents" (Report prepared for the Tennessee Department of Finance and Administration, 25 August 1995).
22. M. Gold et al., "Design and Feasibility of a National Medicaid Access Survey with State-Specific Estimates," Medical Care Research and Review (September 1995): 409-430.