Medicaid Managed Care
This policy brief, based on research conducted by Dr. Todd Eberly for his dissertation, examines whether a transition from fee-for-service to a managed care Medicaid program improved access to preventive well care services, and whether there were differential effects on service use for racial and ethnic minority youths.
CPS Undercounts Maryland Medicaid Enrollment: General population surveys, such as the Census Bureau's Current Population Survey (CPS), are the most common approach to estimating the number of uninsured. These surveys, however, appear to undercount the number of individuals enrolled in Medicaid, sometimes by as much as 40 to 50 percent. The Hilltop Institute (as the Center for Health Program Development and Management) surveyed Maryland Medicaid beneficiaries and found a significant discrepancy between the CPS count and state records.
In this report, Ian Axford Fellow John O'Brien, director of acute care policy at The Hilltop Institute (as the Center for Health Program Development and Management) compares performance measurement in the New Zealand health care delivery system with performance measurement in HealthChoice, Maryland 's Medicaid managed care program. As illustrated by these two health care delivery systems, performance measurement is likely to be an evolving set of metrics that can be applied for a variety of purposes. Indeed, performance measurement offers a window into the biases and thought processes of policymakers and offers important lessons for health care delivery.
In response to recent dramatic increases in Medicaid spending, the Michigan legislature mandated a study evaluating the cost-effectiveness of capitated managed care involving multiple managed care organizations compared to three alternative delivery systems: fee-for-service, primary care case management, and a capitated managed care program involving a single statewide managed care organization. The Hilltop Institute (as the Center for Health Program Development and Management) was retained by the Michigan Department of Community Health to conduct this study.
As Medicaid managed care programs mature, states are looking to refine their methods for measuring and improving the performance of participating health plans. This report serves as a guide for Medicaid agencies who want to develop a performance measurement program using administrative data to evaluate the care provided to enrollees with chronic diseases. The report identifies potential performance indicators that are associated with improved medical outcomes and demonstrates the application of diagnosis-based risk adjustment to performance measurement by profiling six health plans.
This manual, prepared by The Hilltop Institute (as the Center for Health Program Development and Management) under contract with the Centers for Medicare and Medicaid Services (CMS), provides a step-by-step approach for state Medicaid programs implementing health-based risk adjustment for managed care organizations. The guide describes information system, financial, and policy issues states should consider, as well as choices related to selecting and implementing a particular methodology. The manual also discusses approaches taken and challenges encountered by other states.
HealthChoice, Maryland 's Medicaid managed care program, was launched in 1997, with nine managed care organizations participating and 80 percent of the Medicaid population enrolled in the first year. This article describes the history of managed care in Maryland, the process for designing and involving stakeholders in the HealthChoice evaluation, and selected evaluation findings.
This evaluation of the Maryland HealthChoice program, which began in 1997, assessed the program's success relative to its original goals and stakeholders' expectations. The study uses a mix of quantitative data (e.g., encounter data and Maryland Health Services Cost Review Commission data) and qualitative data (e.g., community forums and focus groups) to assess the performance of Maryland 's Medicaid managed care program.
Report in Response to Legislative Request to the Maryland Department of Health and Mental Hygiene to Study the Cost of Providing Access to Managed Care for Medicare + Choice-Eligibles in Maryland,
This report, mandated by the Maryland Legislature, was originally intended to be a cost analysis that would provide the basis for a financial subsidy to encourage the expansion of Medicare+Choice plans across Maryland . However, the study took a more comprehensive approach to describe the national and state context in which Medicare+Choice withdrawals were occurring and the impact of the withdrawals on consumers and health care programs.
Managed care organizations may be incurring financial losses from persons with HIV/AIDS. Using a statistical model to examine comorbidities that contribute to the variation in health care costs for enrollees with HIV/AIDS, this study developed an improved methodology for calculating capitation payments for this population.
This survey of 1,500 Maryland physicians, mandated by the Maryland General Assembly, examined the experience of physicians in the managed care environment and particularly the experience of minority physicians. Physicians were queried about network participation, racial and ethnic discrimination by managed care organizations, and satisfaction with income.