Medicaid Managed Care - U.S. Senate Special Committee on Aging
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Medicaid Managed Care - U.S. Senate Special Committee on Aging

Medicaid Managed Care - U.S. Senate Special Committee on Aging Medicaid Managed Care - U.S. Senate Special Committee on Aging

aging.senate.gov
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29.07.2013 Views

213 WISCONSIN DEPARTMENT OF HEALTH AND FAMILY SERVICES Joe Leean, Secretary DIVISION OF HEALTH J. Jean R67gers, Adminisrrator DIVISION OF HEALTH. BUREAU OF HEALTH CARE FINANCING Peggy L Bartels, Director WISCONSIN MEDICAID FOR MORE INFORMATION. CONTACT Angela Dombrowicki, ong>Managedong> ong>Careong> Section Chief BUREAU OF HEALTH CARE FINANCING One West Wilson Street P.O. Box 309 Madison, WI 53701-0309 Telephone: 608-266-1935 FAX: 608-266-1096 INTERNET ADDRESSES: Ms. Banels: barteple@&dfsstate.wi.us Ms. Dombrowicki: dombra@dfs.staeim.us

214 HMO / Fee-for-Service CO.*PAR&SON RJor 1 HMOs reported higher rates of preventive services than feefor-service in several important areas. ong>Medicaidong> managed care enrollees were reportedly more likely to receive v"well-child" exams (Health~hecks), MMR vaccines, and Pap tests, for example, than fee-for-service recipients. In general, access to care was equal to, or better than, fee-for-service. HIMO enrollees visited primary care providers more and emergency rooms less often than fee-for-service recipients: In the area of mental health, HMOs as a whole reported lower rates of persons receiving services. But, of those receiving mental health care, the average number of services per recipient was nearly the same as fee-for-service. BACKGROUND Wisconsin was one of the first states to contract with health maintenance organizationsr (HM0s) to provide health care sevices to ong>Medicaidong> recipients. Rapidly rising costs. frgmented care delivery and concerns about access to care and quality prompted a search for alternatives to the fee-for-service ong>Medicaidong> system. Since the inception of the Wisconsin ong>Medicaidong> HMO progran in 1984, many other states have followed Wisconsin's lead and have implemented ong>Medicaidong> managed care programs. Because of the success of the first ong>Medicaidong> HMO programs in Milwaukee, Dane, and Eau Claire coundes, managed care for the Aid to Families with Dependent Children (AFDCYHalthy Start population was expanded In 1995,11 HMOs served almost 150.000 ong>Medicaidong> recipients n five Wisconsin counties. By the end of 1997. approximately 200.000 Wisconsin ong>Medicaidong> recipients will receive their health care through 19 HMOs. AFDC and Healthy Start ong>Medicaidong> recipients are. for the most pt childrenti and women in their childbearing years. More than two-thirds are under 2Oyears of age. Almost 90 percentof adlt-lrecipients are women, and less than one percoent are over 50 years of age. The health care challenge for this young and predominantly female population is to provide important preventive seaviccs and to aure access to and continuity of care. The Wisconsin ong>Medicaidong> HMO/Fee-for-Service Comparison Rtpor: 1995 is only one of several ways the Wisconsin ong>Medicaidong> Program reports on and monitors care provided to ong>Medicaidong> recipients in both ong>Medicaidong>-contracted HMOs and fee-for-service health care delivery areas. This report is produced annually. Data for the report reflect care provided to the ong>Medicaidong> AFDC and Healthy Start populations only and are derived from two data sources: data reported by individual Medicad-otiacted HMOs and claims submitted to the Wisconsin ong>Medicaidong> fiscal agen. EDS. The report compares reported health care utilization and occiirrence data among HMOs, among HMO counties, and between HMO and fee-forservice. The report presents 59 indicators. Several are of particular relevance and importance to the AFDClHealthy Start population.

213<br />

WISCONSIN DEPARTMENT OF HEALTH AND FAMILY SERVICES<br />

Joe Leean, Secretary<br />

DIVISION OF HEALTH<br />

J. Jean R67gers, Adminisrrator<br />

DIVISION OF HEALTH. BUREAU OF HEALTH CARE FINANCING<br />

Peggy L Bartels, Director<br />

WISCONSIN MEDICAID<br />

FOR MORE INFORMATION. CONTACT<br />

Angela Dombrowicki, <str<strong>on</strong>g>Managed</str<strong>on</strong>g> <str<strong>on</strong>g>Care</str<strong>on</strong>g> Secti<strong>on</strong> Chief<br />

BUREAU OF HEALTH CARE FINANCING<br />

One West Wils<strong>on</strong> Street<br />

P.O. Box 309<br />

Madis<strong>on</strong>, WI 53701-0309<br />

Teleph<strong>on</strong>e: 608-266-1935<br />

FAX: 608-266-1096<br />

INTERNET ADDRESSES:<br />

Ms. Banels: barteple@&dfsstate.wi.us<br />

Ms. Dombrowicki: dombra@dfs.staeim.us

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