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

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HMO / Fee-for-Service
CO.*PAR&SON RJor 1
HMOs reported higher rates of preventive services than feefor-service in several
important areas. <strong>Medicaid</strong> 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 <strong>Medicaid</strong> 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 <strong>Medicaid</strong> system.
Since the inception of the Wisconsin <strong>Medicaid</strong> HMO progran in 1984, many other states have
followed Wisconsin's lead and have implemented <strong>Medicaid</strong> managed care programs.
Because of the success of the first <strong>Medicaid</strong> 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 <strong>Medicaid</strong> recipients n five Wisconsin counties. By
the end of 1997. approximately 200.000 Wisconsin <strong>Medicaid</strong> recipients will receive their health care
through 19 HMOs.
AFDC and Healthy Start <strong>Medicaid</strong> 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 <strong>Medicaid</strong> HMO/Fee-for-Service Comparison Rtpor: 1995 is only one of several
ways the Wisconsin <strong>Medicaid</strong> Program reports on and monitors care provided to <strong>Medicaid</strong> recipients in
both <strong>Medicaid</strong>-contracted HMOs and fee-for-service health care delivery areas. This report is produced
annually. Data for the report reflect care provided to the <strong>Medicaid</strong> 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 <strong>Medicaid</strong> 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.