As a strategy to better control escalating Medicaid costs, several states switched from a fee-for- service delivery system to mandatory enrollment in managed care plans. In 1994, TennCare replaced the Medicaid program in Tennessee. Under TennCare, managed care was mandated and coverage was expanded. Studies have found that Medicaid managed care programs in other states succeeded in reducing the use of emergency rooms and specialty services, but impacts on the use of inpatient hospital care and physician services have been mixed. This study examines whether the switch to managed care in Tennessee reduced excessive use of high cost services and resulted in recommended levels of preventive care services for Medicaid enrollees.
We will analyze individual-level claims and encounter data to compare the service use of Medicaid enrollees during a two-year period (1992-1993) before managed care was introduced in Tennessee (1994) with service use of enrollees eligible under Medicaid eligibility rules during a two- year period (1996-1997) after this introduction. We will test for changes in the use of emergency room visits for primary care, preventive care services, inpatient hospital services, surgical procedures, and physician office visits. We will use logit, OLS, poisson, and negative binomial regression models and control for Medicaid eligibility group, race, gender, age, Hispanic ethnicity, observation period, managed care plan, time enrolled in Medicaid, and county-level characteristics of the health care market (such as number of physicians per 100,000 people).
Learning Objectives: At the conclusion of this session, participants will be able to discuss evidence indicating whether the switch to managed care in Tennessee resulted in more cost effective use of services
Keywords: Medicaid Managed Care, Cost Issues
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.