1932
0
  1. Home
  2. A-Z Publications
  3. Annual Review of Public Health
  4. Volume 41, 2020
  5. Article

Annual Review of Public Health

Volume 41, 2020

Medicaid Managed Care's Effects on Costs, Access, and Quality: An Update

Abstract

Medicaid is integral to public health because it insures one in five Americans and half of the nation's births. Nearly two-thirds of all Medicaid recipients are currently enrolled in a health maintenance organization (HMO). Proponents of HMOs argue that they can lower costs while maintaining access and quality. We critically reviewed 32 studies on Medicaid managed care (2011–2019). Authors reported state-specific cost savings and instances of increased access or quality with implementation or redesign of Medicaid managed-care programs. Studies on high-risk populations (e.g., disabled) found improvements in quality specific to a state or a high-risk population. A unique model of managed care (i.e., the Oregon Health Plan) was associated with reduced costs and improved access and quality, but results varied by comparison state. New trends in the literature focused on analysis of auto-assignment algorithms, provider networks, and plan quality. More analysis of costs jointly with access/quality is needed, as is research on managing long-term care among elderly and disabled Medicaid recipients.

Keyword(s): access, costs, managed care, Medicaid, quality
Loading

Article metrics loading...

/content/journals/10.1146/annurev-publhealth-040119-094345
2020-04-01
2024-04-20
Loading full text...

Full text loading...

/deliver/fulltext/publhealth/41/1/annurev-publhealth-040119-094345.html?itemId=/content/journals/10.1146/annurev-publhealth-040119-094345&mimeType=html&fmt=ahah

Literature Cited

  1. 1. 
    Anderson MD, Fox PD. 1987. Lessons learned from Medicaid managed care approaches. Health Aff 6:171–86
     [Google Scholar]
  2. 2. 
    Batra P, Hernandez Gray AA, Moore JE 2017. Variation in coverage for progesterone to prevent preterm birth: a survey of Medicaid managed care organizations. Women's Health Issues 27:573–78
     [Google Scholar]
  3. 3. 
    Bell N, Lòpez-DeFede A, Wilkerson RC, Mayfield-Smith K 2018. Precision of provider licensure data for mapping member accessibility to Medicaid managed care provider networks. BMC Health Serv. Res. 18:974
     [Google Scholar]
  4. 4. 
    Bindman A. 2018. Redesigning Medicaid managed care. JAMA 319:1537–38
     [Google Scholar]
  5. 5. 
    Bowers A, Owen R, Heller T 2017. Care coordination experiences of people with disabilities enrolled in Medicaid managed care. Disabil. Rehabil. 39:2207–14
     [Google Scholar]
  6. 6. 
    CBO (Congr. Budget Off.) 2018. Establish caps on federal spending for Medicaid. Options for reducing the deficit: 2019–202841–51 Rep., CBO Washington, DC: https://www.cbo.gov/system/files/2019-06/54667-budgetoptions-2.pdf
    [Google Scholar]
  7. 7. 
    CBO (Congr. Budget Off.) 2018. Exploring the growth of Medicaid managed care Rep. 54235, CBO Washington, DC: https://www.cbo.gov/system/files/2018-08/54235-MMC_chartbook.pdf
  8. 8. 
    Chorniy A, Currie J, Sonchak L 2018. Exploding asthma and ADHD caseloads: the role of Medicaid managed care. J. Health Econ. 60:1–15
     [Google Scholar]
  9. 9. 
    Dranove D, Ody C, Starc A 2017. A dose of managed care: controlling drug spending in Medicaid NBER Work. Pap 23956
  10. 10. 
    Draper DA, Hurley RE, Short AC 2004. Medicaid managed care: the last bastion of the HMO. Health Aff 23:155–67
     [Google Scholar]
  11. 11. 
    Duggan M, Hayford T. 2013. Has the shift to managed care reduced Medicaid expenditures? Evidence from state and local‐level mandates. J. Policy Anal. Manag. 32:505–35
     [Google Scholar]
  12. 12. 
    Gilchrist-Scott DH, Feinstein JA, Agrawal R 2017. Medicaid managed care structures and care coordination. Pediatrics 140:e20163820
     [Google Scholar]
  13. 13. 
    Gordon SH, Gadbois EA, Shield RR, Vivier PM, Ndumele CD, Trivedi AN 2018. Qualitative perspectives of primary care providers who treat Medicaid managed care patients. BMC Health Serv. Res. 18:1728
     [Google Scholar]
  14. 14. 
    Gordon SH, Lee Y, Ndumele CD, Vivier PM, Gutman R et al. 2018. The impact of Medicaid managed care plan type on continuous Medicaid enrollment: a natural experiment. Health Serv. Res. 53:53770–89
     [Google Scholar]
  15. 15. 
    Gottlieb L, Ackerman S, Wing H, Manchanda R 2017. Understanding Medicaid managed care investments in members’ social determinants of health. Popul. Health Manag. 20:302–8
     [Google Scholar]
  16. 16. 
    Graham CL, McDonnell DD. 2016. Seniors’ and people with disabilities’ experiences with mandatory Medicaid managed care in California: populations to target for additional support during transitions. J. Health Care Poor Underserved 27:1819–42
     [Google Scholar]
  17. 17. 
    Hatef E, Vanderver BG, Fagan P, Albert M, Alexander M 2015. Annual diabetic eye examinations in a managed care Medicaid population. Am. J. Manag. Care 21:e297–302
     [Google Scholar]
  18. 18. 
    Healy-Collier K, Jones WJ, Shmerling JE, Robertson KR, Ferry R 2016. Medicaid managed care reduces readmissions for youths with type 1 diabetes. Am. J. Manag. Care 22:250–56
     [Google Scholar]
  19. 19. 
    Hu T, Decker SL, Chou S-Y 2016. Medicaid pay for performance programs and childhood immunization status. Am. J. Prev. Med. 50:S51–57
     [Google Scholar]
  20. 20. 
    Hu T, Mortensen K. 2018. Mandatory statewide Medicaid managed care in Florida and hospitalizations for ambulatory care sensitive conditions. Health Serv. Res. 53:293–311
     [Google Scholar]
  21. 21. 
    Kaiser Family Found 2017. Data note: Medicaid managed care growth and implications of the Medicaid expansion Issue Brief, April 24, Kaiser Family Found Menlo Park, CA: https://www.kff.org/medicaid/issue-brief/data-note-medicaid-managed-care-growth-and-implications-of-the-medicaid-expansion/
  22. 22. 
    Kaiser Family Found 2017. Total Medicaid enrollment in managed long-term services and supports (MLTSS). State Health Facts https://www.kff.org/other/state-indicator/total-medicaid-enrollment-in-managed-long-term-services-and-supports/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D
    [Google Scholar]
  23. 23. 
    Kaiser Family Found 2017. Total Medicaid spending. State Health Facts https://www.kff.org/medicaid/state-indicator/total-medicaid-spending/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D
    [Google Scholar]
  24. 24. 
    Kaiser Family Found 2018. Medicaid managed care penetration rates by eligibility group. State Health Facts https://www.kff.org/medicaid/state-indicator/managed-care-penetration-rates-by-eligibility-group/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%22sort%22:%22asc%22%7D
    [Google Scholar]
  25. 25. 
    Kaiser Family Found 2019. 10 things to know about Medicaid: setting the facts straight Issue Brief, March 6, Kaiser Family Found Menlo Park, CA: https://www.kff.org/medicaid/issue-brief/10-things-to-know-about-medicaid-setting-the-facts-straight/
  26. 26. 
    Keast SL, Skrepnek G, Nesser N 2016. State Medicaid programs bring managed care tenets to fee for service. J. Manag. Care Spec. Pharm. 22:145–48
     [Google Scholar]
  27. 27. 
    Kirkner RM. 2018. Why Medicaid managed care is looking outside the traditional coverage box. Managed Care March 28. https://www.managedcaremag.com/archives/2018/4/why-medicaid-managed-care-looking-outside-traditional-coverage-box
    [Google Scholar]
  28. 28. 
    Kuziemko I, Meckel K, Rossin-Slater M 2018. Does managed care widen infant health disparities? Evidence from Texas Medicaid. Am. Econ. J. Econ. Policy 10:255–83
     [Google Scholar]
  29. 29. 
    Maeng DD, Snyder SR, Baumgart C, Minnich AL, Tomcavage JF, Graf TR 2016. Medicaid managed care in an integrated health care delivery system: lessons from Geisinger's early experience. Popul. Health Manag. 19:257–63
     [Google Scholar]
  30. 30. 
    Marton J, Yelowitz A, Shores M, Talbert JC 2016. Does Medicaid managed care help equalize racial and ethnic disparities in utilization?. Health Serv. Res. 51:872–91
     [Google Scholar]
  31. 31. 
    Marton J, Yelowitz A, Talbert JC 2014. A tale of two cities? The heterogeneous impact of Medicaid managed care. J. Health Econ. 36:47–68
     [Google Scholar]
  32. 32. 
    Marton J, Yelowitz A, Talbert JC 2017. Medicaid program choice, inertia and adverse selection. J. Health Econ. 56:292–316
     [Google Scholar]
  33. 33. 
    McConnell KJ, Renfro S, Chan BK, Meath TH, Mendelson A et al. 2017. Early performance in Medicaid accountable care organizations: a comparison of Oregon and Colorado. JAMA Intern. Med. 177:538–45
     [Google Scholar]
  34. 34. 
    McConnell KJ, Renfro S, Lindrooth RC, Cohen DJ, Wallace NT, Chernew ME 2017. Oregon's Medicaid reform and transition to global budgets were associated with reductions in expenditures. Health Aff 36:451–59
     [Google Scholar]
  35. 35. 
    McDonnell DD, Graham CL. 2015. Medicaid beneficiaries in California reported less positive experiences when assigned to a managed care plan. Health Aff 34:447–54
     [Google Scholar]
  36. 36. 
    Ndumele CD, Cohen MS, Cleary PD 2017. Association of state access standards with accessibility to specialists for Medicaid managed care enrollees. JAMA Intern. Med. 177:1445–51
     [Google Scholar]
  37. 37. 
    Ndumele CD, Schpero WL, Schlesinger MJ, Trivedi AN 2017. Association between health plan exit from Medicaid managed care and quality of care, 2006–2014. JAMA 317:2524–31
     [Google Scholar]
  38. 38. 
    Ndumele CD, Staiger B, Ross JS, Schlesinger MJ 2018. Network optimization and the continuity of physicians in Medicaid managed care. Health Aff 37:929–35
     [Google Scholar]
  39. 39. 
    Oakley LP, Harvey SM, Yoon J, Luck J 2017. Oregon's coordinated care organizations and their effect on prenatal care utilization among Medicaid enrollees. Matern. Child Health J. 21:1784–89
     [Google Scholar]
  40. 40. 
    Palmer M, Marton J, Yelowitz A, Talbert J 2017. Medicaid managed care and the health care utilization of foster children. INQUIRY 54:46958017698550
     [Google Scholar]
  41. 41. 
    Park J. 2015. Length of stay and inpatient costs under Medicaid managed care in Florida. INQUIRY 52:0046958015610762
     [Google Scholar]
  42. 42. 
    Perez V. 2018. Does capitated managed care affect budget predictability? Evidence from Medicaid programs. Int. J. Health Econ. Manag. 18:123–52
     [Google Scholar]
  43. 43. 
    Schwartz AL, Pesa J, Doshi D, Fastenau J, Seabury SA et al. 2016. Medicaid managed care penetration and drug utilization for patients with serious mental illness. Am. J. Manag. Care 22:346–53
     [Google Scholar]
  44. 44. 
    Shrank WH, Keyser DJ, Lovelace JG 2018. Redistributing investment in health and social services—the evolving role of managed care. JAMA 320:2197–98
     [Google Scholar]
  45. 45. 
    Sommers BD, Blendon RJ, Orav EJ 2016. Both the ‘private option’ and traditional Medicaid expansions improved access to care for low-income adults. Health Aff 35:96–105
     [Google Scholar]
  46. 46. 
    Sparer M. 2012. Medicaid managed care: costs, access, and quality of care Res. Synth. Rep. 23, Robert Wood Johnson Found Princeton, NJ:
/content/journals/10.1146/annurev-publhealth-040119-094345
Loading
Medicaid Managed Care's Effects on Costs, Access, and Quality: An Update
Annual Review of Public Health 41, 537 (2020); https://doi.org/10.1146/annurev-publhealth-040119-094345
/content/journals/10.1146/annurev-publhealth-040119-094345
/content/journals/10.1146/annurev-publhealth-040119-094345
Loading

Data & Media loading...

  • Article Type: Review Article

Most Cited Most Cited RSS feed

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error