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Assessing Medicaid managed care in eastern state.

A R Kovner

    Journal of Policy Analysis and Management : [The Journal of the Association for Public Policy Analysis and Management]
    |April 1, 1996
    PubMed
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    This case study explores how state health commissioners can effectively monitor Medicaid managed care programs. It addresses balancing cost containment with ensuring quality healthcare for low-income populations.

    Area of Science:

    • Health Services Research
    • Public Health Policy
    • Healthcare Management

    Background:

    • Managed care programs are increasingly utilized to control escalating healthcare expenditures.
    • Medicaid managed care presents a complex challenge for state health officials, balancing cost containment with quality of care.
    • There is ongoing debate regarding the actual cost savings and potential adverse effects of managed care on healthcare quality.

    Purpose of the Study:

    • To examine the role of managed care in improving healthcare for the poor and controlling costs.
    • To determine effective strategies for a state health commissioner to monitor Medicaid managed care programs.
    • To identify necessary data for assessing healthcare quality, providing feedback, and ensuring credible oversight.

    Main Methods:

    Related Experiment Videos

    • Case study analysis of a large eastern state's health commissioner.
    • Examination of pressures for cost containment and support for managed care.
    • Identification of data requirements for program monitoring and oversight.

    Main Results:

    • The commissioner faces significant pressure for cost containment.
    • Concerns exist regarding the reality of cost savings and potential negative impacts on healthcare quality.
    • The immediate challenge is defining data needs for effective monitoring.

    Conclusions:

    • Effective monitoring of Medicaid managed care requires specific data submission from providers.
    • Data collection should support assessment of healthcare quality and provider feedback.
    • Politically credible program oversight is essential for successful managed care implementation.