Human Services News

From EurekAlert! - Breaking News:

Medicaid managed care enrollees appear to receive lower-quality care than patients enrolled in commercial managed care programs, according to a study in the October 10 issue of JAMA.

"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.

There is limited information in peer-reviewed literature on the quality of care delivered within health plans to Medicaid enrollees.

Bruce E. Landon, M.D., M.B.A., of Harvard Medical School, Boston, and colleagues examined performance on 11 Healthcare Effectiveness Data and Information Set (formerly the Healthplan Employer Data and Information Set) (HEDIS) quality indicators in three types of managed care plans: Medicaid-only plans, commercial-only plans (health plans serving predominantly commercial enrollees), and Medicaid/commercial plans (health plans serving substantial numbers of both types of enrollees).

The 11 indicators were in the categories of prevention and screening (such as breast cancer screening); chronic disease management (such as high blood pressure); and care for pregnant women.

When comparing the quality of care indicators for the Medicaid and commercial populations together, overall commercial population performance exceeded overall Medicaid population performance in all instances except one, ranging from a difference of 4.9 percent for controlling hypertension (58.4 percent for commercial vs. 53.5 percent for Medicaid) to 24.5 percent for rates of appropriate postpartum care (77.2 percent for commercial vs. 52.7 percent for Medicaid).

When comparing performance for Medicaid and commercial populations within the same health plan, performance for the commercial population was uniformly better across all measures.

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