Commercial Managed Care Enrollees Get Better Care Than Medicaid Managed Care Enrollees

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Main Category: Medicare / Medicaid / SCHIP
Also Included In: Health Insurance / Medical Insurance
Article Date: 10 Oct 2007 - 11:00 PDT

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If you are an enrollee in a Medicaid managed care program the chances are that you will receive lower-quality care than somebody in a commercial managed care program, according to a report in the Journal of the American Medical Association (JAMA), October 10th issue.

The authors explain "Although enrollment of commercially insured individuals in health maintenance organizations (HMOs) has decreased in recent years, HMOs continue to provide care for an increasing proportion of the Medicaid population. Between 1994 and 2004, enrollment in Medicaid managed care tripled from 7.9 million beneficiaries to more than 27 million beneficiaries. The proportion of Medicaid beneficiaries in managed care increased from 23 percent to more than 60 percent during the same time period." They add that there is not much peer-reviewed literature on the quality of care given within health plans to Medicaid enrollees.

Bruce E. Landon, M.D., M.B.A., of Harvard Medical School, Boston, and team analyzed the performance on 11 Healthcare Effectiveness Data and Information Set (formerly the Healthplan Employer Data and Information Set) (HEDIS) quality indicators in three kinds of plans:

-- Medicaid-only plans
-- Commercial-only plans (serving mainly commercial enrollees)
-- Medicaid/commercial plans (serving a significant number of both kinds of enrollees)

The 11 indicators were in the categories of chronic disease management (e.g. hypertension), prevention and screening (e.g. breast cancer screening), and care for pregnant women.

Their study involved 383 health plans that reported quality-of-care data to the National Committee for Quality Assurance for the period 2002-2004. These included 142 Medicaid/commercial plans, 37 Medicaid-only plans and 204 commercial-only plans.

When the researchers compared the Medicaid and commercial enrollees, in general the commercial population performance was better than the overall Medicaid population performance in all cases bar one. The difference ranged from 4.9% for controlling high blood pressure (53.5% Medicaid versus 58.4% commercial) to 24.5% for appropriate post natal care (52.7% for Medicaid versus 77.2% for commercial). Only in the case of Chlamydia screening was Medicaid performance better than commercial performance.

When the researchers compared Medicaid and commercial population performances within the same health plan, performance for the commercial population was better across the board.

Performances among Medicaid only plan enrollees and Medicaid/commercial plan enrollees were similar, report the researchers.

The researchers wrote "These findings suggest that the type of health plan enrolling the population (commercial, Medicaid/commercial, or Medicaid-only) is a less important determinant of the quality of care than differences in the characteristics of the population being served, the local provider networks in which they receive care, access to care, patterns of care seeking, and adherence to treatment recommendations."

"Quality of Care in Medicaid Managed Care and Commercial Health Plans"
Bruce E. Landon, MD, MBA; Eric C. Schneider, MD, MSc; Sharon-Lise T. Normand, PhD; Sarah Hudson Scholle, MPH, DrPH; L. Gregory Pawlson, MD, MPH; Arnold M. Epstein, MD, MA
JAMA. 2007;298:1674-1681.
-- Click here to view abstract online

Written by: Christian Nordqvist
Copyright: Medical News Today
Not to be reproduced without permission of Medical News Today

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