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Health plan disenrollment in a choice-based Medicaid managed care program
Thomas C Buchmueller1, Todd Gilmer, Katherine Harris
1Graduate School of Management, University of California, Irvine, Irvine, CA 92612, USA. tcbuchmu@uci.edu
Summary
Consumers who actively choose their Medicaid health plans are less likely to disenroll. Enrollee satisfaction with managed care depends on provider cultural competence, impacting plan retention.
Area of Science:
- Health Services Research
- Health Economics
- Public Health Policy
Background:
- Consumer choice in health plans significantly impacts healthcare quality and risk selection.
- Medicaid managed care programs offer beneficiaries diverse plan options with monthly switching capabilities.
- Understanding disenrollment drivers is crucial for program stability and equitable care access.
Purpose of the Study:
- To investigate factors influencing disenrollment timelines within a Medicaid managed care setting.
- To identify key drivers of beneficiary retention and plan switching behavior.
- To inform policy regarding consumer choice and its impact on managed care programs.
Main Methods:
- Analysis of disenrollment data from a Medicaid managed care program.
- Examination of factors including initial choice, enrollee demographics, and provider characteristics.
- Statistical modeling to assess the relationship between choice, satisfaction, and disenrollment.
Main Results:
- Active plan selection at enrollment significantly reduces disenrollment risk compared to auto-assignment.
- Enrollee ethnicity interacting with provider language proficiency indicates the importance of cultural competence in satisfaction.
- Disenrollment patterns vary by risk status, leading to adverse retention in specific plans.
Conclusions:
- Empowering beneficiaries with informed choice is a key strategy for improving retention in Medicaid managed care.
- Cultural competence in healthcare provision is essential for enhancing enrollee satisfaction and reducing disparities.
- Policy interventions should address risk-based disenrollment to ensure equitable plan participation and care quality.