Managed care quality and disenrollment in New York SCHIP

During the past decade, experts have devoted substantial efforts to quality improvement for managed care. Although a handful of studies have examined the effect of quality on enrollment, few have systematically investigated the association between managed care quality and plan disenrollment, especially among lowincome populations.

To examine whether higher-quality measures in managed care plans are associated with lower disenrollment from the State Children's Health Insurance Program (SCHIP) in New York State.

Observational study of managed care plan disenrollment for a New York statewide cohort of 2206 new SCHIP enrollees.

Managed care quality was measured by 7 Consumer Assessment of Health Plans Survey (CAHPS) scores and 3 Healthcare Effectiveness Data and Information Set (HEDIS) scores, obtained from the 2002 New York State Managed Care Plan Performance Report. Disenrollment was defined as being disenrolled from an SCHIP plan for 2 or more consecutive months based on the New York SCHIP universal billing files.

Nearly 40% of children were disenrolled during the study period. No overall effects of plan quality on disenrollment were detected, but plans with higher scores in "preventive care visits" had a significantly lower disenrollment rate. The disenrollment rate in the eligibility recertification period was 3.2 percentage points higher than that in other time periods.

Disenrollment was not associated with overall managed care plan quality as measured by CAHPS and HEDIS, suggesting that further study is warranted to determine optimal strategies for enhancing managed care quality in the SCHIP population.