Joseph W Thompson1, Kevin W Ryan, Sathiska D Pinidiya, James E Bost. 1. Department of Pediatrics, College of Medicine, Arkansas Center for Health Improvement, University of Arkansas for Medical Sciences, Little Rock 72204, USA. thompsonjosephw@uams.edu
Abstract
CONTEXT: Many states have turned to commercial health plans to serve Medicaid beneficiaries and to achieve cost-containment goals. Assumptions that the quality of care provided to Medicaid beneficiaries through these programs is acceptable have not been tested. OBJECTIVE: To compare the quality of care provided to children and adolescents in commercial and Medicaid managed care in the United States. DESIGN, SETTING, AND POPULATION: Using 1999 data collected through the Health Plan Employer Data and Information Set, we examined reported quality-of-care indicators for children and adolescents. Results from 423 commercial and 169 Medicaid plans were compared. Matched pairs analyses were performed using data from each of the 81 companies serving both populations to control for corporate differences. Correlation coefficients and regression procedures were used to examine observed variations in health plan performance. MAIN OUTCOME MEASURES: Quality indicators including prenatal care, childhood immunizations, well-child visits, adolescent immunizations, and myringotomy and tonsillectomy rates. RESULTS: Using standard indicators of clinical performance, children and adolescents enrolled in Medicaid received worse care compared with their commercial counterparts. For most of the 81 health plans serving both populations, Medicaid enrollees had statistically significantly (P<.001) lower rates than commercial plans for clinical quality indicators (eg, childhood immunization rates of 69% vs 54%); for clinical access indicators (eg, well-child visits in the first 15 months of life, 53% vs 31%); and for common procedures (eg, myringotomies for children aged 0-4 years, 35 vs 2 per 1000 members). Conversely, some plans demonstrated equal and high-quality care for both populations. Regression models failed to identify consistent plan characteristics that explained the observed differences in quality of care. CONCLUSIONS: Most commercial health plans do not deliver high-quality care on a number of performance indicators for children enrolled in Medicaid. Policy makers and the public need plan-specific quality information to inform purchasing decisions.
CONTEXT: Many states have turned to commercial health plans to serve Medicaid beneficiaries and to achieve cost-containment goals. Assumptions that the quality of care provided to Medicaid beneficiaries through these programs is acceptable have not been tested. OBJECTIVE: To compare the quality of care provided to children and adolescents in commercial and Medicaid managed care in the United States. DESIGN, SETTING, AND POPULATION: Using 1999 data collected through the Health Plan Employer Data and Information Set, we examined reported quality-of-care indicators for children and adolescents. Results from 423 commercial and 169 Medicaid plans were compared. Matched pairs analyses were performed using data from each of the 81 companies serving both populations to control for corporate differences. Correlation coefficients and regression procedures were used to examine observed variations in health plan performance. MAIN OUTCOME MEASURES: Quality indicators including prenatal care, childhood immunizations, well-child visits, adolescent immunizations, and myringotomy and tonsillectomy rates. RESULTS: Using standard indicators of clinical performance, children and adolescents enrolled in Medicaid received worse care compared with their commercial counterparts. For most of the 81 health plans serving both populations, Medicaid enrollees had statistically significantly (P<.001) lower rates than commercial plans for clinical quality indicators (eg, childhood immunization rates of 69% vs 54%); for clinical access indicators (eg, well-child visits in the first 15 months of life, 53% vs 31%); and for common procedures (eg, myringotomies for children aged 0-4 years, 35 vs 2 per 1000 members). Conversely, some plans demonstrated equal and high-quality care for both populations. Regression models failed to identify consistent plan characteristics that explained the observed differences in quality of care. CONCLUSIONS: Most commercial health plans do not deliver high-quality care on a number of performance indicators for children enrolled in Medicaid. Policy makers and the public need plan-specific quality information to inform purchasing decisions.
Authors: Jeffery N Epstein; Kelly J Kelleher; Rebecca Baum; William B Brinkman; James Peugh; William Gardner; Phil Lichtenstein; Joshua Langberg Journal: Pediatrics Date: 2014-11-03 Impact factor: 7.124
Authors: Jenny H Yiee; Christopher S Saigal; Julie Lai; Hillary L Copp; Bernard M Churchill; Mark S Litwin Journal: Urology Date: 2012-11 Impact factor: 2.649
Authors: Wendy L Marsh-Tootle; Terry C Wall; John S Tootle; Sharina D Person; Robert E Kristofco Journal: Optom Vis Sci Date: 2008-09 Impact factor: 1.973
Authors: Jinoos Yazdany; Laura Trupin; Chris Tonner; R Adams Dudley; Joann Zell; Pantelis Panopalis; Gabriela Schmajuk; Laura Julian; Patricia Katz; Lindsey A Criswell; Edward Yelin Journal: J Gen Intern Med Date: 2012-05-17 Impact factor: 5.128