265798 Does Medicaid managed care plan type make a difference in enrollee experience and reports of care?

Sunday, October 28, 2012

Allyson Hall, PhD , College of Public Health & Health Professions, University of Florida, Gainesville, FL
Jeffrey Harman, PhD , College of Public Health and Health Professions, Department of Health Services Research, Management, and Policy, University of Florida, Gainesville, FL
Christy Harris Lemak, PhD , Health Management and Policy, University of Michigan, Ann Arbor, MI
Mona Al-Amin, PhD , Healthcare Administration, Suffolk University, Boston, MA
R. Paul Duncan, PhD, MS , Department of Health Services Research, Management, & Policy, University of Florida, Gainesville, FL
Florida Medicaid recently concluded a five year Medicaid managed care demonstration program in 5 counties. A key component of the demonstration was that beneficiaries enroll in one of two types of managed care plans: traditional HMOs and provider service networks (PSNs). There are two structural differences between these two plan types: PSNs were reimbursed based on fee for service, HMOs were capitated; and PSNs were owned by local physician groups or hospitals, most of the HMOs were national organizations. This study explores whether beneficiary reports and ratings of care vary by health plan type, and also before or after mandated Medicaid managed care was introduced. This study involves a secondary analysis of 4 years of CAHPS surveys (n=20,157) of Medicaid beneficiaries. Mulitvariate ordered logit regression models were used to determine whether there were differences in 9 reports and 4 ratings of care by plan type (HMO, PSN) and whether there were changes in reports and ratings before and after mandated Medicaid managed care was introduced. The likelihood of providing a high rating for overall health care declined after the demonstration was implemented (OR .74 95% CI .59,.92). However after the demonstration was initiated, beneficiaries were more likely to provide favorable reports of aspects of their care such as finding a doctor or nurse (OR 1.40 95% CI 1.06, 1.83) or getting care right away (OR 1.48 95% CI 1.08, 2.04), compared to before implementation. PSN enrollees compared to HMO enrollees after implementation relative to before implementation were more likely to provide better ratings for overall health care (OR 1.30 95% CI 1.04, 1.63), personal doctor (OR 1.33 95% CI 1.07, 1.67), and a more favorable report of their doctor spending enough time (OR 1.46 95% CI 1.17, 1.83). PSN enrollees were also more likely to provide specialty care with a favorable rating (OR 1.52 95% CI 1.09, 2.11) compared to HMO enrollees. Findings suggest that although beneficiaries are more likely to rate their overall care negatively after mandated managed care some aspects of their care may have improved , notably the ability to find a doctor and the interactions with that clinician. Experiences under PSN arrangements appear to be preferable to the HMO arrangement.

Learning Areas:
Provision of health care to the public

Learning Objectives:
1. Describe Medicaid managed care in Florida 2. Explain differences in satisfaction and experiences with care across managed care plan types

Keywords: Medicaid, Medicaid Managed Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a PhD trained health services researcher. I conduct research on Medicaid, medical homes, and access to care.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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