Multiple switching in Medicaid managed care: a proportional hazards model

Area of Science:

• Health Services Research
• Managed Care
• Health Economics

Background:

• Understanding member switching behavior in health plans is crucial for stability.
• Medicaid managed care populations exhibit unique switching patterns.
• Identifying predictors of multiple health maintenance organization (HMO) switches is essential for effective management.

Purpose of the Study:

• To identify managerially useful predictors of multiple HMO switches.
• To analyze switching behavior in a large Medicaid managed care population over 33 months.
• To compare different stages of switching behavior.

Main Methods:

• Cox's proportional hazards model applied to eligibility and claims data.
• Analysis of Medicaid services utilization prior to enrollment (n=2,474).
• Telephone interviews conducted with a subset of enrollees (n=656).

Main Results:

• Interruptions in care independently predicted switching.
• Higher medical claims and, to a lesser extent, older age were associated with multiple switches.
• Switching behavior differed from findings in employer-sponsored insurance plans.

Conclusions:

• Interruptions, medical claims, and age are key predictors of HMO switching.
• These predictors offer actionable insights for managers to reduce member churn.
• Findings highlight the need for tailored strategies in Medicaid managed care.