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

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SELECTED INDICATORS
Access to <strong>Care</strong>
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- Children and adolescents in HMOs had slightly higher rates of health care visitsfor aU reasons
(62%) than infee-for-service (57%c).
Percent of recipients (ages 0-20) having at Icast one health care visit in 1995
- HMOs reported that three times as many enrollees were seen byprinary careprovidrs (59%)
than infee-for-service (19%76). Primary <strong>Care</strong> Providers (PCPs) are typically the cmstine of care
provided through HMOs. As the coordinatorofcare, thePCPpmvides a 'nedical home for managed
care recipients.
Percent of-recipients seen by a primary care provider in 1995
nmI|,r
* HMOs reported half as many emergency room vists arfee-for-service (0.6 versut 12 viSitsper
eligibleperyear). Inappropriate emergency room use is often associated with poorcontiuity of care
and unnecessary costs. Especially among the poor, emergency rooms may provide the only medical
services received. Stratries such as assuring that every enrollee has his or her own primary care
provider, that a caregiver is 'on call" 24 hours a day. and that patiets contact their own doctors first in
non life treaseing situations have helped reduce inapp e emergency room use.
Averagenumber of emergency nrom visits per eigible yesar In 1995
' 1111;i les
Children's Health
"Well-baby/cAild" checks, called HealthCheck Scrnms, were reported much morefreqrru,
in HMOs than in fee-for-service for children from the age of birth through five. Fifty-one
percent of children in this age group received a Healthleck from an HMO provider as opposed to orly
32 percent of those i fee-for-service. Of the five HMO couodes, Milwaukee had the highes rate of
screens. HealthChecks are performed to monitor a child's development in a variety of areas and to
provide education to parents. HealthChecks are often timed to coincide with im zns.
Percent of chi dren (ages O-S) who received at least one HealthChe& visit In 1995