PUP 4931r Lecture Notes - Lecture 79: Managed Care, Prescription Drug, Health Maintenance Organization
16 May 2018
School
Department
Course
Professor
MCOs are Not All The Same
The heterogeneous impact of Medicaid managed careJames Marton ̈†Aaron
Yelowitz ̈†Jeffery C. TalbertJournal of Health EconomicsVolume 36, July 2014,
Pages 4768
Compared MCO performance in two KY counties
Difficult due to heterogeneity in reimbursement incentives, etc
Resulted in
large differences in the relative success of each plan
in reducing utilization and spending that are likely driven by important
differences in plan design.
Differences Included
plan that capitated primary care physicians
and contracted out many administrative responsibilities to an experienced
managed care organization
achieved significant reductions in outpatient and professional utilization.
61% reduction
plan that opted for a fee for service reimbursement scheme with a group
withhold and handled administration internally saw a much more modest
reduction in outpatient utilization and an increase in professional utilization.
17% reduction
Suggestive evidence that the reductions in utilization observed in the Louisville
cetered capitated pla did ot lead to adverse health outcoes for asthatic
children, as measured by inpatient hospitalizations.
Favorable Attrition
An Analysis of Disenrollment From Medicare ManagedCare Plans by Medicare
Beneficiaries With Diabetes
find more resources at oneclass.com
find more resources at oneclass.com
Document Summary
The heterogeneous impact of medicaid managed carejames marton aaron. Yelowitz jeffery c. talbertjournal of health economicsvolume 36, july 2014, Difficult due to heterogeneity in reimbursement incentives, etc. Resulted in large differences in the relative success of each plan in reducing utilization and spending that are likely driven by important differences in plan design. Differences included plan that capitated primary care physicians and contracted out many administrative responsibilities to an experienced managed care organization achieved significant reductions in outpatient and professional utilization. 61% reduction plan that opted for a fee for service reimbursement scheme with a group withhold and handled administration internally saw a much more modest reduction in outpatient utilization and an increase in professional utilization. Suggestive evidence that the reductions in utilization observed in the louisville ce(cid:374)tered (cid:862)capitated(cid:863) pla(cid:374) did (cid:374)ot lead to adverse health outco(cid:373)es for asth(cid:373)atic children, as measured by inpatient hospitalizations. An analysis of disenrollment from medicare managedcare plans by medicare.
