Medicaid Managed Care in an Integrated Health Care Delivery System: Lessons from Geisinger's Early Experience

Area of Science:

• Health Services Research
• Managed Care
• Population Health Management

Background:

• States increasingly use managed care organizations for Medicaid.
• Geisinger Health System has managed Medicaid since 2013.
• Focus on complex care needs and social services.

Purpose of the Study:

• To evaluate the impact of Geisinger's integrated care management model on Medicaid members.
• To assess cost of care savings and health outcomes.
• To analyze claims data for specific populations, including those with Supplemental Security Income.

Main Methods:

• Analysis of Geisinger's claims data for Medicaid members.
• Comparison of incurred costs against expected levels.
• Evaluation of inpatient, outpatient, professional, and prescription drug costs.

Main Results:

• Lower inpatient, outpatient, and professional costs observed for Geisinger's Medicaid members.
• Cost savings were partially offset by increased prescription drug expenses.
• Members eligible for Supplemental Security Income showed particular cost reductions.

Conclusions:

• Integrated Medicaid care management shows potential for significant cost savings.
• Data suggest a positive impact on healthcare costs for complex populations.
• Further analysis needed to fully understand long-term effects and cost offsets.