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

McDonnell, Diana D.; Graham, Carrie

doi:10.1377/hlthaff.2014.0528

Cited by 12 publications

(5 citation statements)

References 11 publications

(10 reference statements)

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“…8,23 Challenges with a burdensome enrollment process may be compounded by low Medi-Cal acceptance rates among providers and limited in-network providers within managed care plans. 24 Patients with Medi-Cal also reported a preference for receiving care in the ED or UC. Factors such as social instability and distrust of the health care system may contribute substantially to this theme, though systemic problems may also play a role.…”

Section: Discussionmentioning

confidence: 99%

Barriers to Primary Care After the Affordable Care Act: A Qualitative Study of Los Angeles Safety-Net Patients’ Experiences

et al. 2019

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Purpose: Millions of people gained health care coverage in Los Angeles after the Affordable Care Act (ACA); however, challenges with obtaining and utilizing primary care still persist, particularly in the safety net. In this study, we explore barriers to accessing primary care services among safety-net patients in Los Angeles after Medicaid expansion and implementation of other programs for safety-net patients after the ACA. Methods: We conducted qualitative interviews, in Spanish and English, with 34 nonelderly adult patients in 1 of 3 insurance groups: Medicaid, MyHealthLA (a health care program for low-income undocumented individuals), or uninsured. We recruited participants from three sites in Los Angeles in 2017. We analyzed our interviews using a framework approach and included emerging concepts from participant responses. Results: We identified seven themes regarding barriers to accessing primary care: understanding the concept of primary care, finding a primary care provider (PCP), switching PCPs, getting timely appointments, geography and transportation, perceived cost or coverage barriers, and preferring emergency or urgent care over primary care. Patients with Medicaid were more likely to report barriers compared with other groups. Uninsured patients were less likely to understand the concept of primary care. Patients with MyHealthLA noted getting timely appointments and cost of care to be significant barriers. Conclusion: Despite Medicaid and other coverage expansions for safety-net patients after the ACA, substantial barriers to accessing primary care persist. Addressing such barriers through the development of targeted interventions or broader policy solutions could improve access to primary care for safety-net patients in Los Angeles.

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Section: Discussionmentioning

confidence: 99%

Barriers to Primary Care After the Affordable Care Act: A Qualitative Study of Los Angeles Safety-Net Patients’ Experiences

et al. 2019

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“…New trends in the literature also considered quality variation within HMO managed-care programs. Researchers have shown that algorithms used to auto-assign Medicaid recipients to plans do not produce optimal matches (32,35). Evidence also indicated that high-risk recipients were more likely to switch to higher-quality plans than were low-risk recipients.…”

Section: Qualitymentioning

confidence: 99%

Medicaid Managed Care's Effects on Costs, Access, and Quality: An Update

Montoya

Chehal

Adams

2020

Annu. Rev. Public Health

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Medicaid is integral to public health because it insures one in five Americans and half of the nation's births. Nearly two-thirds of all Medicaid recipients are currently enrolled in a health maintenance organization (HMO). Proponents of HMOs argue that they can lower costs while maintaining access and quality. We critically reviewed 32 studies on Medicaid managed care (2011–2019). Authors reported state-specific cost savings and instances of increased access or quality with implementation or redesign of Medicaid managed-care programs. Studies on high-risk populations (e.g., disabled) found improvements in quality specific to a state or a high-risk population. A unique model of managed care (i.e., the Oregon Health Plan) was associated with reduced costs and improved access and quality, but results varied by comparison state. New trends in the literature focused on analysis of auto-assignment algorithms, provider networks, and plan quality. More analysis of costs jointly with access/quality is needed, as is research on managing long-term care among elderly and disabled Medicaid recipients.

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“…We could not determine from the data available whether an enrollee chose an MCO or was auto-enrolled. Research has shown that this affects enrollee experiences (McDonnell & Graham, 2015), and future research should include that variable in analysis of claims to determine whether choosing an MCO affects PCP and specialist utilization.…”

Section: Limitationsmentioning

confidence: 99%

Utilization of and Relationships With Primary Care Providers During the Transition to Medicaid Managed Care

Owen

Crabb

Stober

et al. 2019

Journal of Disability Policy Studies

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The objective of this study was to determine whether seniors and disabled adults in Illinois’s Medicaid managed care (MMC) were more likely to see, maintain longitudinal relationships with, and have continuity of care with a primary care provider (PCP) compared with fee-for-service (FFS) Medicaid enrollees. Medicaid PCP service claims for 13,221 MMC and 54,625 FFS enrollees were analyzed using an inverse propensity score weighted difference-in-differences design to match the groups by demographic characteristics and historical Medicaid utilization. All data came from Medicaid claims data and corresponding administrative records. Regression analyses showed that enrollment in MMC was significantly related to each of the three outcomes; MMC enrollees were more likely than the FFS group to see a PCP during the 1-year post-period and have high levels of continuity of care with a single PCP. However, FFS enrollees were more likely to maintain a relationship with their PCP providers from the pre-period through the post-period. Therefore, while more people in MMC than FFS visit a PCP each year, for people in MMC, it is often a new provider relationship, which can be problematic for people with disabilities. Additional training for PCPs, to prepare them for working with people with disabilities, and additional efforts to expand the MMC network of providers are needed.

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

Cited by 12 publications

References 11 publications

Barriers to Primary Care After the Affordable Care Act: A Qualitative Study of Los Angeles Safety-Net Patients’ Experiences

Barriers to Primary Care After the Affordable Care Act: A Qualitative Study of Los Angeles Safety-Net Patients’ Experiences

Medicaid Managed Care's Effects on Costs, Access, and Quality: An Update

Utilization of and Relationships With Primary Care Providers During the Transition to Medicaid Managed Care

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