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.
