Mandated Managed Care Will Change Health Care Structure

Article excerpt

As the Medicaid system moves into a managed care model on a state-by-state basis, the entire medical structure in this country will change dramatically and the potential consequences "could be monumental," warns John Kuder, associate professor of health economics and finance.

"We're on a fast-moving train but have no idea where it's going. That much money going into a managed care model will drive the entire way we all get medical services," Kuder says.

With two grants totaling $1.18 million from the Pew Charitable Trusts, Kuder and Robert Hurley of the Medical College of Virginia will study which policies work - and which don't - when it comes to mandated Medicaid managed care.

Specifically, the researchers will examine

* the states' ability to manage enrollment processes to ensure access and fair treatment of all groups, especially at-risk groups such as women and children, in specific managed care programs;

* how beneficiaries negotiate the choices involved in selecting a plan or disenrolling from a plan;

* the influence of Medicaid managed care on services to the uninsured;

* the relationships between private managed care organizations and community health care providers; and

* how health care providers are influenced by mandated Medicaid managed care.

To achieve these goals, the researchers will conduct on-site interviews, develop case studies, and collect relevant quantitative data in four metropolitan communities. To date, only Philadelphia has been identified. They will mail questionnaires to Medicaid recipients who disenroll and then enroll in different managed care programs to analyze the process as well as the reasons. …