Medicaid beneficiaries under managed care: provider choice and satisfaction (original) (raw)
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Addressing Medicaid Expansion from the Perspective of Patient Experience in Hospitals
The Patient - Patient-Centered Outcomes Research, 2016
Background More Medicaid holders are entering the healthcare system consequential to Medicaid expansion. Their experience has financial consequences for hospitals and crucial implications for the provision of patient-centered care. This study examined how the hospital characteristics, especially the rates of Medicaid coverage and racial/ethnic minorities, impact the quality of inpatient care. Methods Using data for years 2009-2011 for 870 observations of California hospitals, and data collected from patients via the Hospital Consumer Assessment of Healthcare Providers and Systems survey coupled with data from the Healthcare Cost and Utilization Project and American Hospital Association Annual Survey, we used a generalized estimating equation approach to evaluate patients' experience with hospital care. Our multivariate model includes a comprehensive set of characteristics capturing market, structural, process, and patient demographics associated with the patient's hospital stay. Results The findings indicate that high concentrations of Medicaid patients in the hospital negatively impact the perceived patient experience. In addition, all things being equal, hospitals with higher concentrations of Hispanic, Black, and Asian patients received lower patient satisfaction results on 28 of the 30 regression coefficients capturing patient satisfaction, with 22 of the 30 negative coefficients statistically significant. Conclusions Hospitals serving higher concentrations of Medicaid patients and more racial/ethnic diverse patients experienced a less satisfactory patient experience than patients utilizing other payers or patients who were White. Our research magnifies the challenge for addressing the disparities that exist in healthcare. Further research is called for clarifying the underlying reasons for these disparities and the optimal strategies for addressing these problems.
Managed Care in Medicaid: Selected Issues in Program Origins, Design, and Research
Annual Review of Public Health, 1987
The search for new methods to provide cost-effective medical care has become the principal concern of health service purchasers, providers, and researchers in the 1980s. This concern has led to bold and innovative strat egies in both the private and public sectors. These strategies are represented by initiatives that run the gamut from highly regulatory to avowedly market oriented competitive ones. Despite these wide variations, such strategies share a common goal of containing cost increases without reductions in service access and quality. In this paper we describe a set of the initiatives used currently in the Medicaid program and discuss how these new approaches are being evaluated to assess whether they attain their specific goals. We begin by discussing the environment that has fostered the search for alternative delivery methods and the legislative and executive activities that have enabled experimentation. We detail the theoretical foundations for these programs of prepaid and managed care and the characteristics of a selected set of them. With the programs broadly outlined, we then describe the evaluation design developed to assess them. Finally, we identify areas for additional research. BACKGROUND The Medicaid program is a federal, state, and local program to provide funding for health services to the poor. Each state sets its own criteria for eligibility by aid and income category, and each administers its own program 137
The American journal of managed care, 2003
The Consumer Assessment of Health Plans Survey (CAHPS) is widely used to evaluate health plans; however there are few reports of Medicaid health plan efforts to improve performance as measured by CAHPS. Data from CAHPS were analyzed to help plan administrators determine how they might address member reports of problems obtaining care they or their doctor believed necessary. Secondary analysis of cross-sectional survey data obtained from adults and children enrolled in 3 Medicaid health plans. Cross-tabulations of CAHPS responses and follow-up questions asking enrollees to describe the problems they had obtaining care believed necessary. Problems obtaining care believed necessary were among the most frequently reported problems (13%-17% of adults, 9% of children). Problems obtaining a satisfactory personal doctor; receiving help when calling a physician's office; securing routine, urgent, and specialist care appointments as soon as desired; receiving referrals to specialists; obt...
Journal of Urban Health, 2000
It is becoming increasingly apparent that over the next several years the majority of Medicaid patients in many states will become enrolled in managed care plans, some voluntarily, but most as the result of mandatory initiatives. An important issue related to this development is the extent to which this movement to managed care is accompanied by serious selection effects, either across the board during the phase in or among individual plans or plan types with full-scale implementation. This paper examines selection effects in New York City between 1993 and 1997 during the voluntary enrollment period prior to implementation of mandatory enrollment pursuant to a Section 1115 waiver. No substantial selection bias was documented between patients entering managed care and those remaining in the fee-for-service system among the largest rate groups, although some selection effect was found among plans and plan types (with investor-owned plans enrolling patients with lower prior utilization and expenses).
Race/ethnicity, socioeconomic status, and satisfaction with health care
American journal of medical quality : the official journal of the American College of Medical Quality
The purpose of the present study was to evaluate the effects of race/ethnicity and socioeconomic status on consumer health care satisfaction ratings. The authors analyzed national data from the 2001 National Research Corporation Healthcare Market Guide Survey (N = 99 102). Four global and 3 composite ratings were examined. In general, satisfaction ratings were high across all global and composite measures; however, Asian/Pacific Islanders and Hispanics gave lower ratings than did whites, and African Americans gave a mix of higher and lower ratings (vs whites). Among the lowest ratings were those given by American Indians/Alaska Natives living in poverty. Race/ethnicity effects were independent of education and income. These findings are consistent with reports of continuing racial/ethnic disparities in both coverage and care. Programs to improve quality of care must specifically address these well-documented, severe, and persistent disparities.
Health Policy Research, 2009
The results and views expressed are the independent products of University research and do not necessarily represent the views of the funding agencies or the University of Iowa. PREFACE This report presents the results of a study of how Iowa Medicaid managed care enrollees rated the health plans they were enrolled in during 2008-2009 on a variety of measures. It was conducted at the request of the Iowa Department of Human Services as part of their continuing quality assurance activities with health plans participating in Medicaid. The basis for the survey instrument was the Consumer Assessment of Healthcare Providers and Systems (CAHPS), which is part of a national effort to evaluate health plans and provide consumers and purchasers with information about the quality of care provided through these plans.
Health plan effects on patient assessments of medicaid managed care among racial/ethnic minorities
Journal of General Internal Medicine, 2004
To examine the extent to which racial/ethnic differences in Consumer Assessment of Health Plans Study (CAHPS) ratings and reports of Medicaid managed care can be attributed to differential treatment by the same health plans (within-plan differences) as opposed to racial/ethnic minorities being disproportionately enrolled in plans with lower quality of care (between-plan differences). DESIGN: Data are from the National CAHPS Benchmarking Database (NCBD) 3.0. Data were analyzed using linear regression models to determine the overall effects, within-plan effects, and between-plan effects of race/ethnicity and language on patient assessments of care. Standard errors were adjusted for nonresponse weights and the clustered nature of the data. PATIENTS/ PARTICIPANTS: A total of 49,327 adults enrolled in Medicaid managed care plans in 14 states from 1999 to 2000. MAIN RESULTS: Non-English speakers reported worse experiences compared to those of whites, while Asian non-English speakers had the lowest scores for most reports and ratings of care. An analysis of between-plan effects showed that African Americans, Hispanic-Spanish speakers, American Indian/ Whites, and White-Other language were more likely than White-English speakers to be clustered in worse plans as rated by consumers. However, the majority of the observed racial/ ethnic differences in CAHPS reports and ratings of care are attributable to within-plan effects. The ratio of between to within variance of racial/ethnic effects ranged from 0.07 (provider communication) to 0.42 (health plan rating). CONCLUSIONS: The observed racial/ethnic differences in CAHPS ratings and reports of care are more a result of different experiences with care for people enrolled in the same plans than a result of racial/ethnic minorities being enrolled in plans with worse experiences. Health care organizations should engage in quality improvement activities to address the observed racial/ethnic disparities in assessments of care.
Managed Care: Effects on the Physician-Patient Relationship
Cambridge Quarterly of Healthcare Ethics, 2000
Over the past several years, healthcare has been profoundly altered by the growth of managed care. Because managed care integrates the financing and delivery of healthcare services, it dramatically alters the roles and relationships among providers, payers, and patients. While analysis of this change has focused on whether and how managed care can control costs, an increasingly important concern among healthcare providers and recipients is the impact of managed care on the physician–patient relationship. The literature includes a number of theoretical articles and anecdotal accounts of managed care's impact on the doctor–patient relationship, but little data have been collected and analyzed. We designed a survey for distribution to Wisconsin physicians to analyze the prevalence and types of managed care arrangements in the state, and the impact of these arrangements on physicians and their relationships with patients.
Consumer Satisfaction with a Managed Health Care Plan
Journal of Consumer Affairs, 1999
This study estimates the effects of four categories of variables hypothesized to influence patient satisfaction with a managed care health benefits plan. Ordinal probit is used to include the full spectrum of information available on the satisfaction measure. Results indicate that personal experience, expectations, and judgments about services covered influence overall satisfaction with the plan. Individual differences have little effect on satisfaction. Knowledge of consumers' perceptions of how they fare when covered by managed care health benefits plans is a missing link in the search for an answer to whether these health care plans will solve the nation's health care woes. Managed care, in general, describes insurance plans based on networks of providers (Miller and Luft 1994). In this study, managed care means a plan in which consumers must choose a primary care physician from a network. To obtain medical services, consumers must first see their chosen primary care physician. This medical professional acts as a gatekeeper to further medical services. Steele (1992) summarized the role of the consumer in shaping health services to meet the needs of both providers and consumers: In order to provide health services which are responsive to consumers' needs, those organizations whose role it is to purchase, provide, or assess health services have a duty to carry out consumer appraisal work. Consumers are experts. They are experts on their own priorities, their own needs, and their own experiences, and they should be consulted as should any other expert group (37). This study examines consumer satisfaction with managed care. It recognizes the importance of the consumer in shaping the provision of qual
Declining Medicaid Fees and Primary Care Appointment Availability for New Medicaid Patients
JAMA Internal Medicine, 2018
Medicaid reimburses physicians at a lower rate and fewer physicians participate in Medicaid when compared to other insurance types. To encourage provider participation in Medicaid, the Affordable Care Act (ACA) increased Medicaid fees to Medicare levels for primary care providers in 2013 and 2014. As expected, the bump in fees resulted in an increase in primary care appointment availability for new Medicaid patients, with larger increases occurring in states with larger increases in fees. Despite the improvements in access, most states returned to lower reimbursement rates in 2015. The question is: did the gains in access in Medicaid erode once fees declined? We conducted a study in which callers simulated new patients with Medicaid and requested appointments from thousands of randomlysampled primary care physicians across ten states before the fee bump was fully introduced (2012 and early 2013) and again during its implementation (2014) and after the Medicaid fee bump expired (2016). We assessed the appointment availability rate, i.e., the percent of requests that resulted in a scheduled appointment. We used state-level Medicaid fees to primary care providers for a level 3 new patient office visit, then measured the changes in fees and changes in appointment availability between 2012 and 2014 to estimate the effect of the increase in fees. We repeated the analyses between 2014 and 2016 to estimate the effect of the fee bump' s removal, partial removal, or retention.