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Medicaid, managed care and optometry: a review
1Center for Vision Care Policy, State College of Optometry, State University of New York, NY 10010, USA.
Journal of the American Optometric Association
|June 1, 1996
Summary
Medicaid managed care enrollment is rising, impacting patient choice and provider reimbursement. Optometrists must adapt to new managed care organization requirements for continued patient access.
Area of Science:
- Health Services Research
- Public Health Policy
- Optometry
Background:
- The U.S. healthcare system is undergoing significant restructuring, with national health reform impacting the public sector.
- Rising healthcare costs are prompting reevaluation of major government entitlement programs, particularly Medicaid.
Purpose of the Study:
- To examine the implications of increased Medicaid managed care enrollment on healthcare delivery.
- To understand the impact on patient access to services and provider participation.
Main Methods:
- Analysis of trends in Medicaid managed care enrollment.
- Review of state-level managed care models and approaches.
- Examination of changes in service delivery and provider networks.
Main Results:
- Medicaid managed care enrollment has increased substantially, with nearly one-fourth of all Medicaid patients now in managed care plans.
- States are implementing managed care arrangements to control costs and improve access to care.
- Managed care organizations are actively seeking Medicaid enrollees.
Conclusions:
- Increased managed care enrollment restricts patient choice to panel practitioners and affects reimbursement for services like vision care.
- Providers, including private optometric practitioners, must adapt to managed care organization requirements, including differing regulations and billing procedures.
- Economic and organizational partnerships with managed care organizations are crucial for provider engagement.