How Good Is Medicaid Managed Care?
This is Aaron Carroll quoting from a Christopher Flavelle study:
The largest Medicaid managed-care plans in Florida and Illinois, and some for-profit plans in California and New York, provide health-care access that is significantly and consistently worse than the national median for such plans. Studies suggest that failing to provide some types of care, such as childhood immunizations, may lead to higher medical costs in the future.
It gets worse:
The evidence is limited that managed care sustainably reduces emergency-room visits in the five largest states. California had shown some reductions in ER visits among managed-care plan patients, but the gap between them and fee-for-service beneficiaries is shrinking. In New York that gap has almost disappeared, and in Illinois, ER visits are now slightly more common among managed-care beneficiaries. Only in Texas does managed care consistently produce significantly lower ER visits than in fee-for-service, though the cost of those visits is much higher.
And, “even in Texas, where managed care is succeeding in reducing the number of emergency room visits, the cost for those visits are, on average, more than twice as expensive as emergency visits under fee-for-service plans.”
Soon we will see which of the worst-performing plans get excluded from certain states’ markets.
Lacking a 24-hour a day alternative to the ER, the incentive of a physician in private practice would be to send a patient to the ER after hours; the incentive of a managed care plan may also be to send a patient to the ER after hours. If it is classified as an emergency, everyone but the hospital is relieved of responsibility for providing care — so why would anyone think managed care would reduce ER visits?
Medicaid enrollees are sicker than average. But is that why they seek care in the ER more than others? Or does Medicaid enrollees’ lack of access to doctors who will treat them cause them to seek care in the ER? Or is it lack of planning to make an appointment ahead of time? It’s hard to separate out cause and effect.
Seems like poor logic or a purposefully biased comment…of course the average cost of ER visits in Texas would be higher – if the people showing at the ER generally require actual emergency services the average cost is obviously going to be higher than in states with high triage-only rates; it’s not rocket science. No Medicaid MCO is contracting at more than 120% of FFS reimbursement rates, much less 200%.