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

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services for non-English-speaking beneficiaries and toll-free telephone lines) at a lower cost than the
state can. Missouri reportedly chose to use a broker because of limits it faced in hiring more state
employees and because it could accelerate implementation with this approach. Ohio, on the other
hand, chose this approach because of a good experience in Dayton, where use of brokers provided a
neutral source of information (GAO 1996b).
Availability of Information
As noted above, beneficiary education and counseling can be critical to the success of managed-care
initiatives. Although none of the studies reviewed here had data from beneficiaries to judge how wellinformed
or satisfied they were with the enrollment process, they agreed on the importance of the
information proccss. Furthermore, they agreed that the content of the information and the process by
which it is communicated are critical. The source of information is less vital, provided it is neutral and
unbiased.
GAO's report noted that all four states selected for their exemplary programs took responsibility in
some way for the task of informing beneficiaries about how best to access care in a managed-care
system and how to choose a plan. These tasks are particularly important for a clientele having only
limited experience with managed care or its restrictions on provider use (GAO 1996b).
States chose to use in-person meetings and mail or telephone contacts, depending on available
resources and how rapidly decisions had to be made. GAO concluded that states seemed to prefer inperson
interactions where possible. Whether these sessions occur in small groups or as individual
interactions, they give counselors a chance to explain complex materials and choices. States that use
mail or telephone contacts may use in-person consultations as a backup. All four states studied also
used community-based groups to supplement the state's educational programs. The GAO study did
not, however, report in detail on the content or subject matter of informational materials or meetings
(GAO 1996b).
The Kaiser/Commonwealth study pointed to similar findings in drawing lessons from the five state
experiences. For example, it cited the importance of an enrollment process that includes written
materials designed for low-income populations, a toll-free telephone number that can address a large
volume of questions, and a means of providing in-person counseling (Gold et al. 1996).
There are many issues related to the content of the information provided. Beyond factual data on plan
characteristics that beneficiaries need to make choices, good information about provider networks is
also needed. In addition, experts cite the importance of performance data, including the use of
<strong>Medicaid</strong>'s edition of the Health Plan Employer Data and Information Set (HEDIS). According to
the NASHP survey, 27 states used some version of HEDIS. Only two, however, used reports cards as
an educational strategy (Horvath and Kaye 1997). Many of these issues parallel similar issues that the
Commission has addressed for the Medicare program (see Chapter 7).
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