Online Program

Navigating managed care: Assessing quality of services reported by patients with disabilities, transitioned from Medicaid fee-for-service (FFS) into a large urban Medicaid managed care plan

Tuesday, November 5, 2013

S. Rae Starr, MPhil, MOrgBehav, HealthCare Outcomes & Analysis, L.A. Care Health Plan, Los Angeles, CA
Starting in 2011, California transitioned Medicaid patients with disabilities from fee-for-service (FFS) into managed care coverage. Agencies, health plans, providers, families, and the advocacy community share an interest in monitoring how these patients have fared in accessing services and navigating managed care. This 2013 study amplifies a 2012 pilot study, with all affected former-FFS patients now fully-transitioned into managed care (June 2011 to May 2012).

(1) Study design: The analysis uses an oversample of former-FFS patients surveyed in CAHPS 2013, covering services in the latter half of 2012. The study is designed to identify impacts of the transition and identify opportunities for improving services.

(2) Setting: Data are from a large urban Medicaid health plan in southern California, serving a diverse population.

(3) Descriptive findings: The presentation reports former-FFS patients' assessments about the quality of health care services in managed care. On CAHPS, patients assess health plans, primary care doctors, specialists, health care, ease of access, speed of access, provider communication, customer service, as major facets of health care.

(4) Analysis: The study compares the quality of services reported by former-FFS patients with disabilities versus the health plan's general Medicaid population. Former-FFS patients are contrasted with a sample of patients with disabilities already in managed care. These comparisons seek to identify areas for improvement in services to patients displaced from FFS.

(5) Other implications: The discussion will include lessons learned about the impact of the transition on patients, clinics, health plan operations, and the design of services.

Learning Areas:

Biostatistics, economics
Chronic disease management and prevention
Conduct evaluation related to programs, research, and other areas of practice
Implementation of health education strategies, interventions and programs
Planning of health education strategies, interventions, and programs
Program planning

Learning Objectives:
Describe how former-Fee For Services (FFS) patients in Medicaid rate the quality of health care services in managed care. Contrast ratings services by former-FFS patients with disabilities versus the general Medicaid population, to identify facets of health care needing improvement. Compare ratings of health care services by patients with disabilities who opted into managed care, versus patients transitioned into managed care from FFS, to identify areas with special need. Identify health care services for which former-FFS adults and children with disabilities, as groups, manifest different problems or needs. Describe lessons learned in adapting services to accommodate incoming former-FFS patients with disabilities.

Keyword(s): Disability, Medicaid Managed Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Served seven years as Senior Biostatistician at the largest public health plan in the United States, serving a diverse Medicaid population. Managed CAHPS and related surveys from 2006 to 2012 to obtain actionable information to guide the design of quality improvement interventions. Developed and conducted a survey of patients living with disabilities. Designed oversamples in CAHPS 2012 and CAHPS 2013 to track patients with disabilities transitioned in California from Medicaid fee-for-service into managed 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.