Tuesday, January 26, 2016

Article finds Medicaid managed care offers mixed results

Echoing CT’s experience, researchers writing in the Journal of Managed Care & Specialty Pharmacy found little evidence that states’ rush to move Medicaid members into risk-based commercial managed care plans has saved money or improved quality. Currently half of all Medicaid members nationally are enrolled in these plans. States moving to commercial managed care are seeking cost reductions, budget predictability, and improved access to care. While capitation does provide short term budget predictability, evidence for overall cost control or improved access to care is lacking. The authors also note that most states, like CT, without commercial plans have already taken advantage of managed care’s main tools, including intensive care management, patient-centered medical homes, disease management and prior authorization. Consequently there is little opportunity for more improvement by simply switching to a different form of management. In fact, since switching away from commercial plans, CT’s Medicaid program has experienced significant savings along with improvements in both quality and access to care.