The Effects of Plan Switching in Medicaid Managed Care on Access and Continuity of Care

医疗补助管理式护理中的计划转换对护理的可及性和连续性的影响

• 批准号: 10225064
• 负责人: Christopher D Frenier
• 金额: $ 3.64万
• 依托单位: UNIVERSITY OF MINNESOTA
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-04-01 至 2022-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10225064
• 关键词: Effects; Plan; Switching; Medicaid; Managed

Project Summary/Abstract Most Medicaid beneficiaries receive coverage through a private Medicaid Managed Care (MMC) plan. MMC plans compete for enrollees by offering high quality coverage with access to desirable providers. States use competitive bidding to select high quality, low-cost MMC plans for enrollees to choose from. Plan choice and competitive bidding can promote quality and efficiency in MMC if enrollees sort into high quality plans and/or states are willing to exclude low quality plans from their Medicaid programs. Both these mechanisms may require enrollees to switch plans, which could also negatively affect quality if patients lose access to providers or experience disruptions in their care due to these transitions. Despite the large and growing role of MMC in covering vulnerable populations, little is known about how switching between MMC plans affects health care quality or utilization. Data limitations, unstable enrollment, and state- level policy differences make it difficult to produce evidence on how Medicaid patients’ health care use changes after enrolling in a new MMC plan. This study examines the effect of plan switching among people covered by Minnesota Health Care Programs (MHCP), Minnesota’s set of Medicaid, Children’s Health Insurance Program, and Basic Health Plan options. I will evaluate the impact of changing MMC plans on (1) longitudinal continuity of care and (2) utilization outcomes, including outpatient visits, emergency room use, hospital admissions, and preventable hospital admissions. My empirical strategy focuses on people enrolled in MMC plans that were dropped from MHCP following Minnesota’s competitive bidding process. Between 2014 and 2016, more than 400,000 people were forced to enroll in a new MHCP plan because their previous plan did not bid on, or failed to win, a state contract to offer MMC coverage. I will use a difference-in-differences framework to compare outcomes among enrollees who experienced these “forced switches” to enrollees whose MMC plan remained available. Data for this project comes from the Minnesota All Payer Claims Database. Findings from this study will inform state policy makers and practitioners about the impact of plan switching on health care access and quality for Medicaid patients. The results will help improve state health care programs by evaluating how plan choice and contracting policies affect continuity of care and health care use.

项目总结/摘要 大多数医疗补助受益人通过私人医疗补助管理医疗（MMC）获得保险 计划MMC计划通过提供高质量的覆盖范围来争夺注册者， 理想的供应商。各州采用竞争性招标来选择高质量、低成本的MMC计划 供报名者选择。方案选择和竞争性投标可促进质量和 如果登记者选择高质量计划和/或州愿意排除低质量计划，则MMC的效率 医疗补助计划的质量计划。这两种机制都可能要求注册者 转换计划，如果患者失去与提供者的联系， 由于这些转变，他们的护理受到干扰。尽管有巨大的和不断增长的作用， MMC在覆盖弱势群体方面的作用，人们对MMC之间如何转换知之甚少。 计划影响卫生保健质量或利用率。数据限制、不稳定的注册和状态- 水平的政策差异使得很难提供关于医疗补助患者健康状况的证据 加入新的MMC计划后，护理使用发生变化。本研究探讨了计划的效果 在明尼苏达州医疗保健计划（MHCP）覆盖的人群中切换，明尼苏达州的医疗保健计划 医疗补助，儿童健康保险计划和基本健康计划选项。我会评价 变更MMC计划对（1）纵向护理连续性和（2）利用率的影响 结果，包括门诊就诊、急诊室使用、住院，以及 可预防的入院治疗我的经验策略主要针对MMC注册的人 在明尼苏达州的竞标过程中，MHCP放弃了这些计划。 2014年至2016年期间，超过40万人被迫参加新的MHCP计划 因为他们之前的计划没有竞标，或者没有赢得一份提供MMC的州合同， 覆盖我将使用差异中的差异框架来比较 经历过这些“强制切换”的注册者改为保留MMC计划的注册者 available.该项目的数据来自明尼苏达州所有付款人索赔数据库。结果 从这项研究将告知国家政策制定者和从业人员的影响， 为医疗补助患者提供医疗保健服务和质量。结果将有助于改善 通过评估计划选择和合同政策如何影响国家卫生保健计划， 护理和保健使用的连续性。