Health Plan Disenrollment in a Choice-Based Medicaid Managed Care Program

Buchmueller, Thomas C.; Gilmer, Todd; Harris, Kerry F.

doi:10.5034/inquiryjrnl_41.4.447

Cited by 10 publications

(4 citation statements)

References 33 publications

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“…In the epidemiologic literature, factors associated with health plan disenrollment have not been previously explored in commercially insured adults but have been identified in Medicare managed care and Medicaid enrollees. [12][13][14][15][16][17][18][19][20][21] Similar to our findings, studies in older adult populations with Medicare insurance generally report that increased frailty and health care utilization are associated with health plan disenrollment from managed care plans. One study of community-dwelling, Medicare managed care enrollees concluded that poor perceived physical and mental health, and a decline in health in the past year independently predicted disenrollment.…”

Section: Discussionsupporting

confidence: 85%

“…In the epidemiologic literature, factors associated with health plan disenrollment have not been previously explored in commercially insured adults but have been identified in Medicare managed care and Medicaid enrollees . Similar to our findings, studies in older adult populations with Medicare insurance generally report that increased frailty and health care utilization are associated with health plan disenrollment from managed care plans.…”

Section: Discussionsupporting

confidence: 83%

See 1 more Smart Citation

Informative censoring by health plan disenrollment among commercially insured adults

Butler

Todd

Sahrmann

et al. 2019

Pharmacoepidemiology and Drug

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Purpose Health plan disenrollment occurs frequently in commercial insurance claims databases. If individuals who disenroll are different from those who remain enrolled, informative censoring may bias descriptive statistics as well as estimates of causal effect. We explored whether patterns of disenrollment varied by patient or health plan characteristics. Methods In a large cohort of commercially insured adults (2007‐2013), we examined two primary outcomes: (a) within‐year disenrollment between January 1 and December 30, which was considered to occur due to patient disenrollment from the health plan, and (b) end‐of‐year disenrollment on December 31, which was considered to occur due to either patient disenrollment from the health plan or withdrawal of the entire health plan from the commercial insurance database. In yearly cohorts, we identified factors independently associated with disenrollment by using log‐binomial regression models to estimate risk ratios (RR) and 95% confidence intervals (CI). Results Among 2 053 100 unique patient years, the annual proportion of within‐year disenrollment remained steady across years (range, 13% to 14%) whereas the annual proportion of end‐of‐year disenrollment varied widely (range, 8% to 26%). Independent predictors of within‐year disenrollment were related to health status, including age, comorbidities, frailty, hospitalization, emergency room visits, use of durable medical equipment, use of preventive care, and use of prescription medications. In contrast, independent predictors of end‐of‐year disenrollment were related to health plan characteristics including insurance plan type and geographic characteristics. Conclusions Differential risk of disenrollment suggests that analytic approaches to address selection bias should be considered in studies using commercial insurance databases.

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Section: Discussionsupporting

confidence: 85%

“…In the epidemiologic literature, factors associated with health plan disenrollment have not been previously explored in commercially insured adults but have been identified in Medicare managed care and Medicaid enrollees . Similar to our findings, studies in older adult populations with Medicare insurance generally report that increased frailty and health care utilization are associated with health plan disenrollment from managed care plans.…”

Section: Discussionsupporting

confidence: 83%

Informative censoring by health plan disenrollment among commercially insured adults

Butler

Todd

Sahrmann

et al. 2019

Pharmacoepidemiology and Drug

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show abstract

“…Beneficiaries who choose their own plans also are more likely to stay enrolled than those who do not choose. 9,10 Despite the benefits of choosing their own plans, many people do not do so. A common way to address this lack of choice is to use "intelligent assignment" algorithms that are designed to select plans for nonchoosing beneficiaries based on their previous health care use, the availability and characteristics of available providers, and other data.…”

mentioning

confidence: 95%

Medicaid Beneficiaries In California Reported Less Positive Experiences When Assigned To A Managed Care Plan

McDonnell¹,

Graham

2015

Health Affairs

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In 2011 California began transitioning approximately 340,000 seniors and people with disabilities from Medicaid fee-for-service (FFS) to Medicaid managed care plans. When beneficiaries did not actively choose a managed care plan, the state assigned them to one using an algorithm based on their previous FFS primary and specialty care use. When no clear link could be established, beneficiaries were assigned by default to a managed care plan based on weighted randomization. In this article we report the results of a telephone survey of 1,521 seniors and people with disabilities enrolled in Medi-Cal (California Medicaid) and who were recently transitioned to a managed care plan. We found that 48 percent chose their own plan, 11 percent were assigned to a plan by algorithm, and 41 percent were assigned to a plan by default. People in the latter two categories reported being similarly less positive about their experiences compared to beneficiaries who actively chose a plan. Many states in addition to California are implementing mandatory transitions of Medicaid-only beneficiaries to managed care plans. Our results highlight the importance of encouraging beneficiaries to actively choose their health plan; when beneficiaries do not choose, states should employ robust intelligent assignment algorithms.

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“…If providers and their staff stigmatize Medicaid enrollees to a greater degree than PeachCare children, this will result in a different experience in the provider office. While it is unclear whether the differences in satisfaction between enrollees in S-CHIP and Medicaid result from objective or perceived differences in treatment, it is likely that lower levels of satisfaction will reduce the likelihood of remaining covered and accessing care in the future (Buchmueller, Gilmer, & Harris, 2004). Thus, states may wish to consider the potential of differential stigma across programs to affect care experiences of children.…”

Section: Policy Implicationsmentioning

confidence: 99%

The stigma of public programs: Does a separate S‐CHIP program reduce it?

Ketsche

Adams

Minyard

et al. 2007

J Policy Anal Manage

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Previous studies suggest access to and satisfaction with care may be different for enrollees in S-CHIP and Medicaid, but it is unclear whether those differences are fully explained by socioeconomic characteristics of the enrollees. We analyze access and satisfaction of three groups of children: Medicaid enrolled, S-CHIP enrolled, and children who are income eligible for Medicaid but carry a card similar to the state's S-CHIP children's card. Both enrollees and providers may believe that these children are enrolled in S-CHIP despite the fact that reimbursement is through the state's Medicaid system. Results indicate that the same network of providers treat, or are perceived by families to treat, the three groups differently. They support the notion that some of the differences in satisfaction between S-CHIP and Medicaid enrollees are related to unmeasured characteristics (for example, income) of the families in the different programs, but that programmatic identity contributes substantially to differential care experience.

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Health Plan Disenrollment in a Choice-Based Medicaid Managed Care Program

Cited by 10 publications

References 33 publications

Informative censoring by health plan disenrollment among commercially insured adults

Informative censoring by health plan disenrollment among commercially insured adults

Medicaid Beneficiaries In California Reported Less Positive Experiences When Assigned To A Managed Care Plan

The stigma of public programs: Does a separate S‐CHIP program reduce it?

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