March 11, 2005
Susan Beasy Latto, Director, UMD Public Relations (218) 726-8830, email@example.com
Dr. George Avery, Instructor, UMD Dept. of Psychology and Management Studies, (218) 726-7364, firstname.lastname@example.org
Medicaid Study by UMD Instructor Published in
The American Journal of Managed Care
Dr. George Avery, Instructor in the UMD Departments of Psychology and Management Studies, was co author of an article published in the March '05 issue of The American Journal of Managed Care. The article is titled "Physician Evaluations of Care Management Practices in Medicaid Programs."
Dr. Avery teaches courses in healthcare management and research methods at UMD. He holds a Master's Degree in Public Administration from the University of Arkansas at Little Rock, and a Ph.D in Health Services Research, Policy, and Administration from the University of Minnesota (U of M) School of Public Health. His research interests include healthcare quality, regulatory policy, and public health policy.
About the article:
During the 1990s, Medicaid programs adopted a strategy of contracting with managed care plans to organize and deliver care to beneficiaries. Medicaid programs contract with managed care plans of two general types: plans that have provider networks that serve predominantly the Medicaid population and the uninsured and/or are created to contract with Medicaid (PM plans); and commercial plans that have large provider networks that serve predominantly private sector enrollees (PC plans).
For this study, physicians in the networks of eight managed care plans participating in the Medicaid program were surveyed regarding availability and usefulness of care management practices and the overall quality of care management. The responses of physicians in plans serving predominantly Medicaid enrollees were contrasted with responses of physicians in commercial plans who cared for Medicaid enrollees.
The study found that physicians in commercial plans reported greater availability of care management practices. No pattern of differences were noted in ratings of the usefulness of practices if available. Physicians in commercial plans rated the quality of care management higher than did physicians in predominantly Medicaid plans. However, there still remains room for substantial improvement for both commercial and other Medicaid contracting plans.
The study concludes that commercial plans do add value to the Medicaid program, and efforts to discourage their withdrawal from participation are justified. However, physician evaluations support the potential for better care management in all types of contracting plans. The results are timely for policymakers in light of recent withdrawals of PC plans from Medicaid managed care programs and the increasing reliance of Medicaid on PM plans to accomplish program objectives.
Co-authors of the article are Douglas Wholey, Professor of Health Services Research at the U of M School of Public Health, and Jon Christianson, Chair of the Department of Healthcare Management and the Director of the Center for the Study of Health Care Management at the U of M Carlson School of Management.