Most state Medicaid programs have adopted managed care designs to provide health services to low-income populations, with the central goals of reducing costs and improving quality of care. However, because these programs have only recently been implemented, there is very little evidence about the performance of Medicaid managed care organizations and the factors that might explain differences among them. This presentation examines differences in enrollee outcomes among managed care organizations participating in four Medicaid programs--Hawaii's QUEST, Oklahoma's Sooner Care, Rhode Island's RIte Care, and Tennessee's TennCare.
Based on telephone survey data of households in each of the states collected in 1998 and 1999, we compared nearly 30 measures of access to, quality of, and satisfaction with care for beneficiaries enrolled in Medicaid managed care organizations in each of the states for several subgroups.
To date, we have analyzed only the Tennessee findings, and so far, the experiences of TennCare enrollees differed in many dimensions across managed care organizations. However, the association between performance and other characteristics of the managed care organizations, such as tax status of the parent company and financial incentives to the providers of care, is quite weak.
Based on the findings from one of the four states, it is apparent that the performance of managed care organizations is more likely to be associated with methods of managing care for specific subgroups rather than with broad structural characteristics of the organizations.
Learning Objectives: This presentation examines differences in enrollee outcomes among managed care organizations participating in four state Medicaid programs
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: None
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.