Commercial managed care plans leaving the Medicaid Managed Care Program in New York State: Impact on quality and access |
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Authors: | Mr. Patrick J. Roohan MS Mary Beth Conroy MPH Joseph P. Anarella MPH Jacqueline M. Butch MBA Foster C. Gesten MD |
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Affiliation: | (1) New York State Department of Health, Office of Managed Care, Bureau of Quality Management and Outcomes Research, Corning Tower, Empire State Plaza, 12237 Albany, NY |
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Abstract: | To develop sufficient managed care capacity to accomplish the goal of transitioning Medicaid recipients into managed care, state policymakers have relied on commercial health maintenance organizations to open their panels of providers to the Medicaid population. However, while commercial health maintenance organization involvement in Medicaid managed care was high initially, since 1996 New York State has had 14 commercial plans leave the New York State Medicaid Managed Care Program. It has been speculated that the exodus of these commercial plans would have a negative impact on Medicaid enrolleeś access and quality of care. This paper attempts to evaluate the impact of this departure from the perspective of quality and access measures and plan audit performance. Univariate and multivariate analyses were performed to evaluation the effect of commercial managed care plans leaving the Medicaid program. The overall performance of plans that remained in the program was compared to that of the plans that chose to leave for the two time periods 1996–1997 and 1998–2000. Access to care, quality of care, and annual audit performance data were analyzed. The departure of commercial health plans from the New York State Medicaid Managed Care Program has not had a statistically significant negative effect on the quality of care provided to Medicaid recipients as evaluated by standardized performance measures. In addition, there were no instances when there was a negative impact of the exit of the commercial plans on access to care. Managed care plans that chose to remain in Medicaid passed the Quality Assurance Reporting Requirements audit at a significantly (P<.01) higher rate than plans that chose to leave. |
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Keywords: | Access to care Commercial managed care Health care delivery Managed care Medicaid managed care Quality assessment |
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