The evolving role and care management approaches of safety-net Medicaid managed care plans.
This article provides new empirical data about the viability and the care management activities of Medicaid managed-care plans sponsored by provider organizations that serve Medicaid and other low-income populations. Using survey and case study methods, we studied these "safety-net" health plans in 1998 and 2000. Although the number of safety-net plans declined over this period, the surviving plans were larger and enjoying greater financial success than the plans we surveyed in 1998. We also found that, based on a partnership with providers, safety-net plans are moving toward more sophisticated efforts to manage the care of their enrollees. Our study suggests that, with supportive state policies, safety-net plans are capable of remaining viable. Contracting with safety-net plans may not be an efficient mechanism for enabling Medicaid recipients to "enter the mainstream of American health care," but it may provide states with an effective way to manage and coordinate the care of Medicaid recipients, while helping to maintain the health care safety-net for the uninsured.
Gusmano
Michael K
MK
International Longevity Center, USA.
Sparer
Michael S
MS
Brown
Lawrence D
LD
Rowe
Catherine
C
Gray
Bradford
B
D000068:Accreditation; D019090:Case Management; D019468:Disease Management; D019538:Health Care Surveys; D006801:Humans; D019458:Insurance Coverage / Q000639:trends*; D008329:Managed Care Programs / Q000458:organization & administration* / Q000706:statistics & numerical data; D008396:Maryland; D008484:Medicaid / Q000191:economics / Q000458:organization & administration*; D017057:Medically Uninsured; D011203:Poverty; D011785:Quality Assurance, Health Care; D013221:State Health Plans / Q000458:organization & administration / Q000706:statistics & numerical data; D014481:United States