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

Abstract

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.

Mandatory Statewide Medicaid Managed Care in Florida and Hospitalizations for Ambulatory Care Sensitive Conditions

“…We use a difference‐in‐differences (DD) model, which is increasingly being used in empirical research focusing on health care policy (Dimick and Ryan ), Medicaid (Mortensen ), and Medicaid managed care (Hu, Chou, and Deily ; Marton et al. ) to evaluate the research question.…”

“…We use a difference-in-differences (DD) model, which is increasingly being used in empirical research focusing on health care policy (Dimick and Ryan 2014), Medicaid (Mortensen 2010), and Medicaid managed care (Hu, Chou, and Deily 2015;Marton et al 2016) to evaluate the research question. Specifically, we compare the change in the incidence of PQIs among Medicaid patients relative to the change among privately insured patients, assuming the trend for the privately insured patients reflects the secular trend in outcomes.…”

The Impact of Medicaid Managed Care on Obstetrical Care and Birth Outcomes: A Case Study

“…To carry out the analysis, we create a dummy variable for a highrisk pregnancy: it equals 1 (a high-risk pregnancy) if a woman has at least one pre-existing condition (these conditions include anemia, cardiac disease, acute/chronic lung disease, diabetes, genital herpes, hemoglobinopathy, chronic hypertension, and renal disease) or at least one complication hard to prevent by medical care (such complications are malpresentation, cord prolapse, abruption placenta, and premature rupture of membrane); and it equals 0 (a normal-risk pregnancy) if she does not have any condition or complication mentioned above. 16 In panel 2 of Table 5, we control for this dummy variable (results on this variable suppressed) and its interaction with the HealthChioces variable. Note the point estimate on the HealthChoices variable now captures the effect on normalrisk pregnancies.…”

“…8 Moreover, the recent works are inconclusive regarding cesarean section, use of high-tech obstetrical procedures, maternal health and health behaviors, and hospital care. 5,6,8,12,13,15,16 This study provides new evidence on MMC, which examines implementation of the Pennsylvania's (PA) Health-Choices program. This program implemented mandatory HMO enrollment among the Medicaid recipients.…”

“…Prior evaluation of the HealthChoices program indicates, first, its capitation payment system considerably lowers the overall reimbursements, through coordinated care and restricted access to high-quality care; second, the program actively identifies high-and low-cost users to serve the goal of tailoring care to members' level of need, which also facilitates risk selections among competing plans; third, implementation of the program, which influences take-up of Medicaid coverage and selective enrollment into plans (partly due to the enrollment exemption), is associated with fewer acute pregnancy complications; moreover, it has led to unexpectedly high demand for the HMO care providers. 16,19,20 Since these features of the HealthChoices can influence maternal obstetrical care, access to high-quality hospital care, and birth outcomes in different directions, it is unclear what the net effect would be. To answer this question, the present study uses a unique dataset that consists of Medicaid-eligible women who resided in PA and had multiple singleton births during the years of HealthChoices expansion.…”