Determinants of provider selection or assignment in a mandatory case management program and their implications for...

Area of Science:

• Health Services Research
• Managed Care Policy
• Consumer Behavior in Healthcare

Background:

• Mandatory managed-care programs for Medicaid beneficiaries require enrollees to select a gatekeeper provider.
• A significant portion of beneficiaries do not actively choose a provider and are assigned one.
• Understanding the characteristics of assigned versus selected beneficiaries is crucial for program evaluation.

Purpose of the Study:

• To compare the health status and prior healthcare experiences of assigned versus selected Medicaid beneficiaries.
• To investigate the utilization experiences of both groups within managed care.
• To identify potential factors influencing beneficiary choice or lack thereof in managed care enrollment.

Main Methods:

• Utilized consumer survey data from the Missouri Managed Health Care Project.
• Compared demographic and health characteristics of assigned beneficiaries with those who selected a gatekeeper.
• Analyzed healthcare utilization patterns for both groups.

Main Results:

• Assigned beneficiaries reported better health status compared to selected beneficiaries.
• Assigned beneficiaries were less likely to have had a regular source of care before enrollment.
• Healthcare utilization experiences were similar between assigned and selected groups.

Conclusions:

• The decision not to select a gatekeeper provider appears to stem from indifference rather than specific preferences or issues.
• Findings suggest that assigned beneficiaries may represent a healthier population segment less engaged with the prior healthcare system.
• Program design and outreach may need to consider the motivations and characteristics of beneficiaries who do not actively choose providers.