The 130th Annual Meeting of APHA

Abstract #48777

John F. Newman, PhD, Institute of Health Administration, Georgia State University, University Plaza, Atlanta, GA 30303, 404/651-2998, jnewman@gsu.edu

Managed Care: Does It Have a Future in Medicaid & Medicare?

Medicaid and Medicare managed care (MC) programs have continued to increase in enrollment. Currently, about 55% of the Medicaid population is enrolled in MC, compared to 14% in 1993. In 1999 Medicare enrolled 6.8million persons in MC plans. Despite the success of MC, there is concern that termination of managed care plans adversely affects enrollees while calling into question the long-term viability of MC within Medicare and Medicaid. The thesis of this paper is that MC will evolve and remain a viable alternative to traditional fee-for-serviced plans in the public sector. We begin with an overview of trends in enrollment and plan types in Medicaid and Medicare. We then explore two themes. The first is that MC is here to stay and that some form of MC is likely to exist into the foreseeable future. While many, including, do not believe that MC as we currently know it will last, others suggest that MC in some form, will be around well into the 21st century. The second theme is that the managed care plans in the future will face an entirely different environment than they do today. It has been suggested that hospitals and other providers will by-pass managed care plans and directly contract with employers and state and local governments decision-making, as opposed to health plan decision-making. The analysis concludes with the observation that Medicare and Medicaid MC programs are likely to undergo significant changes in the future

Learning Objectives: At the conclusion of the session, participants will be able to

• Describe Medicaid and Medicare managed care enrollment trends and plan types. 2.Describe two themes in the future evolution of managed care programs in Medicaid and Medicare.
• Idenitfy future significant changes in Medicaid and Medicare managed care programs.

Keywords: Managed Care, Medicare/Medicaid

Presenting author's disclosure statement:
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.