Primary care case management for Medicaid recipients: evaluation of the Maryland Access to Care program.
A growing number of states are implementing Medicaid managed care programs, and primary care case management (PCCM) is an important component of many of these systems. In this paper, we present results of an evaluation of one such PCCM program--the Maryland Access to Care (MAC) program. The evaluation uses five years of Medicaid claims and eligibility data from the period before and after the program's introduction to determine the program's impact on expenditures and service utilization. Results indicate that the program increased the probability that a Medicaid enrollee would use primary care and preventive services, but had little impact on use of specialty or emergency room services. The gatekeeper program also was successful at controlling expenditures once an enrollee entered the health care system, largely through reductions in the use of ancillary services. The post-MAC increase in the probability of using services was so great, however, that all savings per user were negated, resulting in an estimated increase of about 3.4% in Medicaid expenditures for the MAC-eligible population.
Schoenman
J A
JA
Project HOPE Center for Health Affairs, Bethesda, MD 20814-6133, USA.
Evans
W N
WN
Schur
C L
CL
D000368:Aged; D019090:Case Management / Q000458:organization & administration*; D003363:Cost Control; D005260:Female; D005102:Health Expenditures; D006297:Health Services Accessibility; D006302:Health Services Research; D006801:Humans; D007344:Insurance Claim Reporting; D008297:Male; D008329:Managed Care Programs / Q000458:organization & administration*; D008396:Maryland; D008484:Medicaid / Q000458:organization & administration*; D008875:Middle Aged; D017059:Models, Econometric; D011320:Primary Health Care / Q000458:organization & administration*; D015397:Program Evaluation; D012017:Referral and Consultation; D013221:State Health Plans / Q000458:organization & administration*; D014481:United States