PUP 4931r Lecture Notes - Lecture 76: Managed Care, Health Maintenance Organization, Psychiatric Medication
16 May 2018
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Managed Care vs. Fee for Service
Percent of Medicaid Enrollees in FFS vs MCO vs PCPM
https://www.kff.org/medicaid/state-indicator/share-of-medicaid-population-
covered-under-different-delivery-
systems/?currentTimeframe=0&sortModel=%7B%22colId%22:%22Location%22,%
22sort%22:%22asc%22%7D
CMS data show 41% of Medicaid beneficiaries nationwide were in FFS
arrangements in 2014,
Wide variation among states;
2015 Medicaid Survey data suggest that millions remain in these
arrangements.
Fee for service (FFS) been used for decades by states and federal government and
private sector.
Fees based upon usual cost of care, or reported expenses, or fee schedule set by
payer
For either a specific service
Or cost of facility/divided by total number of patients/divided by % of total
that are patients of the payer (such as Medicare or Medicaid)
FFS encourages more volume and more expensive procedures, little
concern by provider with costs of care
Also fragmented, uncoordinated care, duplications, gaps, unnecessary self-
referral, kickbacks, fraud
May lead to poor quality care if no not much competition, or un-
savvy patients
2015 % of beneficiaries in FFS arrangements varied widely
0 to 100%
In 22 states, the majority of Medicaid beneficiaries were served through
FFS arrangements.
Nationwide, it was about 55% in managed care arrangements in 2015
Disabled beneficiaries were among the most likely to be served through FFS
arrangements
find more resources at oneclass.com
find more resources at oneclass.com
Document Summary
Percent of medicaid enrollees in ffs vs mco vs pcpm https://www. kff. org/medicaid/state-indicator/share-of-medicaid-population- covered-under-different-delivery- systems/?currenttimeframe=0&sortmodel=%7b%22colid%22:%22location%22,% Cms data show 41% of medicaid beneficiaries nationwide were in ffs arrangements in 2014, 2015 medicaid survey data suggest that millions remain in these arrangements. Fee for service (ffs) been used for decades by states and federal government and private sector. Fees based upon usual cost of care, or reported expenses, or fee schedule set by payer. Or cost of facility/divided by total number of patients/divided by % of total that are patients of the payer (such as medicare or medicaid) Ffs encourages more volume and more expensive procedures, little concern by provider with costs of care. Also fragmented, uncoordinated care, duplications, gaps, unnecessary self- referral, kickbacks, fraud. May lead to poor quality care if no not much competition, or un- savvy patients. 2015 % of beneficiaries in ffs arrangements varied widely. In 22 states, the majority of medicaid beneficiaries were served through.
