Effect of privatized managed care on public insurance spending and generosity: Evidence from Medicaid

Perez, Victoria

doi:10.1002/hec.3608

Cited by 7 publications

(3 citation statements)

References 26 publications

(22 reference statements)

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“…Moreover, CBH's incentives are aligned with DBHIDS's imperative to improve the quality of behavioral health services while ensuring the financial viability of implementation initiatives. This is unlike other cities and states in the United States, which have delegated Medicaid management to several commercial insurers ( Perez, 2018 ). The increased fragmentation and insurers’ focus on cost reduction in other city and state Medicaid systems make the kind of coordination and resource investments that were necessary in PACTS more challenging.…”

Section: Discussionmentioning

confidence: 99%

Implementing trauma-focused cognitive behavioral therapy in Philadelphia: A 10-year evaluation

Last,

Johnson,

Dallard

et al. 2023

Implementation Research and Practice

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Background: In 2012, Philadelphia's Department of Behavioral Health and Intellectual disAbility Services (DBHIDS) developed an initiative to implement an evidence-based treatment for posttraumatic stress disorder (PTSD), trauma-focused cognitive behavioral therapy (TF-CBT), across the city's behavioral health system. This report evaluates the initiative's 10-year implementation and effectiveness outcomes. Method: The Exploration, Preparation, Implementation, and Sustainment framework guided our implementation evaluation. The implementation outcomes include adoption, reach, and sustainment; these were obtained during regular evaluation data collection from publicly funded behavioral health agencies participating in the TF-CBT initiative. We analyze effectiveness outcomes (i.e., changes in PTSD symptoms) from a subset of patients receiving TF-CBT, which were collected in 6-month intervals by our research team between 2013 and 2021. Results: From 2012 to 2021, DBHIDS trained 478 clinicians in TF-CBT across 20 behavioral health agencies. During this time, 23,401 youths were screened for potentially traumatic events and PTSD symptoms, and 7,550 youths received TF-CBT. Through the TF-CBT initiative, the city expanded the network of TF-CBT providers from 3 to 20 agencies. DBHIDS sustained this network by maintaining the participation of 16 behavioral health agencies over the course of a decade. The subset of 202 youths who were evaluated to assess TF-CBT effectiveness was drawn from 94 therapists and 20 agencies across Philadelphia. All participating youths completed a baseline assessment, and 151 (75%) completed at least one follow-up assessment. Linear mixed-effects models accounting for observations nested within participants and nested within clinicians found that treatment significantly reduced PTSD symptoms. Conclusion: Between 2012 and 2021, DBHIDS successfully implemented and sustained TF-CBT across the city's behavioral health system. Adoption, reach, and sustainment of TF-CBT were high. Despite the considerable adverse experiences faced by youths seeking treatment in Philadelphia's behavioral health system, TF-CBT was effective. Future directions to improve TF-CBT implementation in the next iteration of the initiative are described.

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Section: Discussionmentioning

confidence: 99%

Implementing trauma-focused cognitive behavioral therapy in Philadelphia: A 10-year evaluation

Last,

Johnson,

Dallard

et al. 2023

Implementation Research and Practice

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“…Information Asymmetry between Managed Care Organizations and Providers: Implications for Healthcare Fraud in the USA There are complex and diverse relationships between healthcare fraud and information asymmetry among healthcare providers in the U.S. Information asymmetry occurs when one side of a transaction or connection has more information than the other, and it can lead to opportunities for exploitation or unethical behavior (Capelleveen et al, 2016;Perez, 2017).…”

Section: Impacts Of Information Asymmetry and Fraudmentioning

confidence: 99%

From Allegations to Actions: Examining the Impact of Fraud Reporting Mechanisms in Healthcare

Amponsah

2024

Preprint

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Introduction: The U.S. healthcare sector is characterized by a diverse mix of public and private funding and provision, resulting in a lack of a singular governing philosophy. Both the public and private sectors are known for providing high-quality medical services. However, since 1980, healthcare spending in the U.S. has substantially increased. The immense size and financial resources of the healthcare sector make it a prominent target for fraudulent activities. Aim This study investigated the impact of collaborative efforts between managed care organizations (MCOs) and oversight agencies on the detection and reduction of healthcare fraud within the Illinois Medicaid program. Method This study examines how collaboration between MCOs and oversight agencies impacts healthcare fraud in Illinois Medicaid. A FOIA request for complaint data was sent to the Illinois Department of Healthcare and Family Services. The Illinois Medicaid Office of the Inspector General oversees program integrity and maintains e database to prevent the enrollment of excluded providers. Results As of September 20, 2023, 2,741 providers were sanctioned, including 857 physicians, 679 waiver service providers, 159 pharmacies, and 157 Medicare providers. Over the period from September 2022 to August 2023, 1,059 fraud referrals were recorded, with internal data mining contributing the most (448) and County Care being the top-referring MCO (260 cases). The collaborative efforts between MCOs and the Medicaid – Office of Inspector General led to the identification of $23,830,110 in questioned costs, resulting in a recovery of $13,441,726 in fiscal year 2021. Conclusion/Recommendation: The findings emphasize the significance of data sharing and transparency in the fight against fraud. The imposition of sanctions on errant healthcare providers has emerged as a key deterrent against fraudulent activities. To combat fraud and information gaps, a comprehensive strategy is needed. This includes empowering patients, improving communication, using advanced analytics, and enforcing regulations. User-friendly digital platforms provide reliable information, enabling informed decisions and reducing disparities. Strengthened collaboration and advanced analytics are crucial for early fraud detection, preserving healthcare integrity, and preventing financial losses.

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“…These recent studies have typically found that shifting Medicaid recipients away from government‐administered plans and into the responsibility of private insurers does not reduce spending or budget variability, on average—and may even lead to higher spending in some contexts (Perez, 2018a; Burns, 2009; Duggan and Hayford, 2013; Duggan, 2004). However, other work shows meaningful savings from managed care use, perhaps as much as 3% lower state Medicaid spending for every 10% increase in MCO enrollment (Perez, 2018b). Additionally, Marton, Yelowitz, and Talbert (2014) find that the design of these managed care plans plays a crucial role in restraining service utilization and reducing costs, at least for children.…”

Section: Introductionmentioning

confidence: 99%

Treatment flows after outsourcing public insurance provision: Evidence from Florida Medicaid

Munnich

Richards

2020

Health Economics

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While politics can determine what public goods are available, elected officials must decide on the method of allocation. Commonly, governments provide public health insurance directly or pay private parties to administer it on their behalf. Such contracting can leverage private sector expertise but also raises agency concerns. In particular, little is known about how private provision of public health insurance impacts medical decision-making and treatment flows for low-income populations. An example comes from the Medicaid program, which has increasingly relied on outside insurers to deliver health services to enrollees. We exploit a large legislative intervention in Florida to show that Medicaid managed care (MMC) organizations generally do not skimp on short-run treatment delivery in the inpatient setting. In fact, patients with severe and chronic illnesses receive more inpatient services under these contracts, especially in relation to managing care transitions. We also document increased competition in the MMC market following the state's policy intervention.

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Effect of privatized managed care on public insurance spending and generosity: Evidence from Medicaid

Cited by 7 publications

References 26 publications

Implementing trauma-focused cognitive behavioral therapy in Philadelphia: A 10-year evaluation

Implementing trauma-focused cognitive behavioral therapy in Philadelphia: A 10-year evaluation

From Allegations to Actions: Examining the Impact of Fraud Reporting Mechanisms in Healthcare

Treatment flows after outsourcing public insurance provision: Evidence from Florida Medicaid

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