Moving to Mandatory Medicaid Managed Care in Ohio

Kenney, Genevieve M.; Sommers, Anna; Dubay, Lisa

doi:10.1097/01.mlr.0000167180.03824.fb

Cited by 14 publications

(15 citation statements)

References 14 publications

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“…We observed a trend toward earlier diagnosis among Medicaid managed care patients compared to Medicaid patients without managed care, that was statistically significant for stage IV versus stage I colon cancer. While studies comparing outcomes between Medicaid managed care and non-managed care patients are limited, available literature suggests that Medicaid managed care patients receive more frequent preventive care services [43,44] and may have better outcomes for conditions associated with on-going care [45], although this has not been found by all investigators [46]. Our results suggest that Medicaid managed care patients may have had better colorectal cancer screening and/or more timely follow-up to abnormal screening results or lower gastrointestinal symptoms than did non-manage care patients.…”

Section: Discussionmentioning

confidence: 99%

Factors Associated with Colon Cancer Stage at Diagnosis

Halpern

Pavluck

Ko³

et al. 2009

Dig Dis Sci

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We analyzed data from 1998-2004 from the National Cancer Data Base to evaluate associations between patient/treatment facility factors and stage at diagnosis for all colon cancers combined and by anatomic location. Compared to patients with private insurance, uninsured patients were significantly more likely to present with advanced-stage disease; Medicaid patients had likelihoods of advanced-stage colon cancer in-between those of privately insured and uninsured patients. Increased odds of advanced-stage colon cancer at diagnosis were also observed among Black (vs. White) patients, women (vs. men), and patients from low socioeconomic status (SES) regions (vs. those from higher SES regions). While the likelihood of advanced-stage disease at diagnosis decreased in later years overall, this decrease was not observed among patients with ascending colon cancers. Screening disparities may lead to more advanced stage at diagnosis among colon cancer patients; programs to improve access to screening among underserved populations may address this disparity.

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Section: Discussionmentioning

confidence: 99%

Factors Associated with Colon Cancer Stage at Diagnosis

Halpern

Pavluck

Ko³

et al. 2009

Dig Dis Sci

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“…This is possibly due to more mixed effects from county to county, but those could not be detected in this analysis due to smaller sample sizes in those counties. A parallel paper (Kenney, Sommers, and Dubay 2003) found improvements in prenatal care use and smoking behavior for white women covered by Medicaid in other mandatory counties using a somewhat different methodology.…”

Section: Discussionmentioning

confidence: 99%

The Impact of Medicaid Managed Care on Pregnant Women in Ohio: A Cohort Analysis

Howell¹,

Dubay²,

Kenney³

et al. 2004

Health Services Research

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Objective. To examine the impact of mandatory HMO enrollment for Medicaidcovered pregnant women on prenatal care use, smoking, Cesarean section (C-section) use, and birth weight. Data Sources/Study Setting. Linked birth certificate and Medicaid enrollment data from July 1993 to June 1998 in 10 Ohio counties, 6 that implemented mandatory HMO enrollment, and 4 with low levels of voluntary enrollment (under 15 percent). Cuyahoga County (Cleveland) is analyzed separately; the other mandatory counties and the voluntary counties are grouped for analysis, due to small sample sizes. Study Design. Women serve as their own controls, which helps to overcome the bias from unmeasured variables such as health beliefs and behavior. Changes in key outcomes between the first and second birth are compared between women who reside in mandatory HMO enrollment counties and those in voluntary enrollment counties. County of residence is the primary indicator of managed care status, since, in Ohio, women are allowed to ''opt out'' of HMO enrollment in mandatory counties in certain circumstances, leading to selection. As a secondary analysis, we compare women according to their HMO enrollment status at the first and second birth. Data Collection/Extraction Methods. Linked birth certificate/enrollment data were used to identify 4,917 women with two deliveries covered by Medicaid, one prior to the implementation of mandatory HMO enrollment (mid-1996) and one following implementation. Data for individual births were linked over time using a scrambled maternal Medicaid identification number. Principal Findings. The effects of HMO enrollment on prenatal care use and smoking were confined to Cuyahoga County, Ohio's largest county. In Cuyahoga, the implementation of mandatory enrollment was related to a significant deterioration in the timing of initiation of care, but an improvement in the number of prenatal visits. In that county also, women who smoked in their first pregnancy were less likely to smoke during the second pregnancy, compared to women in voluntary counties. Women residing in all the mandatory counties were less likely to have a repeat C-section. There were no effects on infant birth weight. The effects of women's own managed care status were inconsistent depending on the outcome examined; an interpretation of these results is hampered by selection issues. Changes over time in outcomes, both positive and negative, were more pronounced for African American women. Conclusions. With careful implementation and attention to women's individual differences as in Ohio, outcomes for pregnant women may improve with Medicaid 825

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“…Researchers usually have information about the mother (age, race, income, sometimes education, and marital status), and a few also have some controls for the quality of the hospital where the delivery takes place (e.g., whether the hospital is a teaching hospital; whether there is a neonatal intensive care unit). Many, therefore, examine whether, controlling for mother and some hospital characteristics, managed care improved utilization of prenatal care and/or improved health outcomes, usually the incidence of low birth weight babies (Carey, Weis, and Homer ; Goldfarb et al ; Krieger, Connell, and LoGerfo ; Schulman, Sheriff, and Momany ; Levinson and Ullman ; Oleske et al ; Griffin et al ; Moreno ; Conover, Rankin, and Sloan ; Koroukian, Bush, and Rimm ; Tai‐Seale et al ; Howell et al ; Kenney, Sommers, and Dubay ; Sommers, Kenney, and Dubay ; Aizer, Currie, and Moretti ). In some articles, changes in the rate of Cesarean sections (C‐sections) (Carey, Weis, and Homer ; Moreno ; Koroukian, Bush, and Rimm ) or changes in expenditures (Tai‐Seale et al ; Duggan 2004) are examined.…”

Section: Literature Reviewmentioning

confidence: 99%

Pregnancy outcomes for medicaid patients in mandatory managed care: The Pennsylvania HealthChoices program

Deily²

2015

Southern Economic Journal

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A number of states have adopted mandatory managed care to provide health services to Medicaid patients, raising concerns that the care provided may be of lower quality than care provided under traditional fee-for-service arrangements. In this article, we study the effect of Pennsylvanias mandatory managed care program, HealthChoices, on health outcomes and the cost of care for pregnant Medicaid patients. Using difference-in-differences, we find evidence that the adoption of managed care resulted in fewer preventable complications, particularly for more severely ill mothers, but no general reduction in costs except in the highest decile of the cost distribution.

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Moving to Mandatory Medicaid Managed Care in Ohio

Abstract: Even with the improvements related to Medicaid managed care, rates of inadequate prenatal care and maternal smoking remain relatively high. Addressing the underlying risk factors that are facing poor women and further expanding public programs may be critical to achieving further progress.

Cited by 14 publications

References 14 publications

Factors Associated with Colon Cancer Stage at Diagnosis

Factors Associated with Colon Cancer Stage at Diagnosis

The Impact of Medicaid Managed Care on Pregnant Women in Ohio: A Cohort Analysis

Pregnancy outcomes for medicaid patients in mandatory managed care: The Pennsylvania HealthChoices program

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