Abstract
To develop sufficient managed care capacity to accomplish the goal of transitioning Medicaid recipients into managed care, state policymakers have relied on commercial health maintenance organizations to open their panels of providers to the Medicaid population. However, while commercial health maintenance organization involvement in Medicaid managed care was high initially, since 1996 New York State has had 14 commercial plans leave the New York State Medicaid Managed Care Program. It has been speculated that the exodus of these commercial plans would have a negative impact on Medicaid enrolleeś access and quality of care. This paper attempts to evaluate the impact of this departure from the perspective of quality and access measures and plan audit performance. Univariate and multivariate analyses were performed to evaluation the effect of commercial managed care plans leaving the Medicaid program. The overall performance of plans that remained in the program was compared to that of the plans that chose to leave for the two time periods 1996–1997 and 1998–2000. Access to care, quality of care, and annual audit performance data were analyzed. The departure of commercial health plans from the New York State Medicaid Managed Care Program has not had a statistically significant negative effect on the quality of care provided to Medicaid recipients as evaluated by standardized performance measures. In addition, there were no instances when there was a negative impact of the exit of the commercial plans on access to care. Managed care plans that chose to remain in Medicaid passed the Quality Assurance Reporting Requirements audit at a significantly (P<.01) higher rate than plans that chose to leave.
Key Words: Access to care, Commercial managed care, Health care delivery, Managed care, Medicaid managed care, Quality assessment
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References
- 1.Health Care Financing Administration. Medicaid Managed Care Enrollment Report. Available at: http:/www.hcfa.gov/medicaid/. Accessed June 6, 2000.
- 2.Felt-Lisk S. Kaiser Commission on Medicaid and the Uninsured. The Changing Medicaid Managed Care Market—Trends in Commercial Plan Participation. Menlo Park, CA: The Henry J. Kaiser Family Foundation; 1999. [Google Scholar]
- 3.Robbins R. HMO defections slow Georgia's Medicaid effort. Atlanta Business Chronicle. 1998;21:5A–5A. [Google Scholar]
- 4.Bailit M. Purchasing in a Turbulant Market: an Assessment of Medicaid Managed Care in the Mid-Atlantic States. Princeton, NJ: Center for Health Care Strategies; 1999. [Google Scholar]
- 5.McCue MJ, Hurley RE, Draper DA, Jurgensen M. Reversal of fortune: commercial HMOs in the Medicaid market. Health Aff. 1999;18(1):223–230. doi: 10.1377/hlthaff.18.1.223. [DOI] [PubMed] [Google Scholar]
- 6.New York State Public Health Law, Chapter 41, 1992.
- 7.New York State Department of Health. The Partnership Plan. Available at: http:// www.health.state.ny.us/nysdoh/mancare/mcmain.htm.Accessed June 6, 2000.
- 8.New York State Department of Health. Quality Assurance Reporting Requirements, a Report on Managed Care Plan Performance 1998. Available at: http://www.health. state.ny.us/nysdoh/mancare/mcmain.htm. Accessed June 6, 2000.