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

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Other studies attest to improved access and equivalent or better outcomes for older
people in managed care. A 1994 article reviewed 16 studies comparing the quality of
care provided by HMOs to care provided to similar populations by other delivery
systems. The article found HMO quality of care to be equal to or better than care
provided by other delivery systems in 14 of 17 indicators. 6 Another study concluded
that Medicare HMO enrollees are more likely to receive mammograms than those
on fee-for-service (62% versus 39%). This study also found that low income and
African American HMO enrollees were even more likely than the average HMO
enrollee to receive a mammogram. 7 Finally, another study found no differences in
access, satisfaction, and quality of care among <strong>Medicaid</strong> beneficiaries enrolled HMOs
and those in fee-for-service. This study found that HMO enrollees had lower
utilization but were equally as healthy as fee-for-service beneficiaries. (Health
outcomes measured included: general health status, physical functioning, activities
of daily living, visual acuity, blood pressure and diabetic control). 8
Although not directly applicable to many state-based efforts these studies
demonstrate that managed care can have both positive and negative impacts on the
care delivered to members of special populations. Also, the Ware and Experton
studies offer an important caution to states undertaking managed care with special
populations: traditional HMO approaches proven to work with average people may
have different results with special populations. As states expand into this area, they
should be deliberate in their strategies, build in strong quality oversight
mechanisms, and remain flexible enough to make midcourse corrections as needed.
What Are the Program's Goals?
Given the untested nature of risk-based managed care for persons with disabilities
and the elderly, why would a state want to apply this approach to these special
populations? It is important for any state to ask itself this question early on, and to
establish goals and objectives that will guide the development and refinement of its
managed care initiative.
In every state, older people and people with disabilities account for a
disproportionate share of total <strong>Medicaid</strong> expenditures, stemming from above
average use of expensive, institution based care. Community care, when it is
available, is often marked by a confusing array of services that may or may not be
1994.
6 Robert H. Miller and Harold S. Lult, Journal of the American Medical Association, May
7 Nelson, et al, Physician Payment Review Commission, November 1996.
8 Lurie, et al., Annals of Internal Medicine, March 1994.
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