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

项目摘要/摘要 大多数医疗补助受益人通过私人医疗补助管理型医疗(MMC)获得保险 计划。MMC计划通过提供高质量的保险和访问 理想的供应商。各州使用竞争性招标来选择高质量、低成本的MMC计划 供参赛者选择。方案选择和竞标可以促进质量和 如果投保人选择高质量计划和/或州政府愿意排除低质量计划，则MMC的效率 他们的医疗补助计划中的高质量计划。这两种机制都可能要求参与者 改变计划，这也可能对质量产生负面影响，如果患者失去与提供者或 由于这些过渡，他们的护理工作受到了干扰。尽管它扮演着越来越大的角色 关于MMC在覆盖弱势人群方面的作用，人们对MMC之间的切换知之甚少 计划影响医疗质量或利用率。数据限制，注册不稳定，以及州- 水平政策的差异使得很难拿出证据来证明医疗补助患者的健康 在注册新的MMC计划后，请注意使用更改。这项研究考察了计划的效果 明尼苏达州医疗保健计划(MHCP)覆盖的人群之间的切换，明尼苏达州的SET 医疗补助、儿童健康保险计划和基本健康计划选项。我会评估 改变MMC计划对(1)纵向连续性护理和(2)利用率的影响 结果，包括门诊就诊、急诊室使用、住院和 可预防的入院。我的经验主义策略关注的是参加MMC的人 明尼苏达州竞标过程后从MHCP中删除的计划。 2014至2016年间，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未能赢得提供MMC的国家合同 覆盖范围。我将使用差异中的差异框架来比较 经历这些“强制转换”的投保人仍保留MMC计划的投保人 可用。这个项目的数据来自明尼苏达州所有付款人索赔数据库。发现 这项研究将向州政策制定者和实践者通报计划的影响 为医疗补助患者打开医疗保健渠道和质量。结果将有助于改进 通过评估计划选择和合同政策对国家医疗保健计划的影响 护理和保健使用的连续性。

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.