Diabetic patient experiences in a Medicaid managed care system.
OBJECTIVE
When Tennessee received a federal waiver to place all Medicaid enrollees in managed care organizations (MCOs), patients with chronic conditions such as diabetes were deemed especially vulnerable. This survey assessed patients' perceptions of diabetic care, self-care procedures, and satisfaction with medical care before and after enrollment in a Medicaid MCO.


METHODS
A telephone survey was designed and pilot tested before surveying 57 patients meeting inclusion criteria of continuous enrollment in Medicaid for two years before, and in the MCO for two years after, the initiation of Tennessee's Medicaid managed care system (TennCare).


RESULTS
On average, patients were 56.1 +/- 8.9 years old (mean +/- SD), African American (87.7%), female (73.7%), disabled (64.8%), with 8.4 +/- 2.8 years of education and annual incomes below $10,000 (54.4%). Mean age at diagnosis was 39.5 +/- 11.5 years, and most (75.5%) were currently prescribed insulin. Over one-third (39.6%) described the quality of healthcare received under managed care as excellent or very good and 38.9% felt prior Medicaid care was worse or much worse. Compared to Medicaid, patients reported no difference in being denied a test under managed care because of lack of approval (P = .754). However, significant improvements were reported in receiving detailed information about diabetes (89.5% vs. 73.7%, P = .022), and diet (89.5% vs. 77.2%, P = .039) for the TennCare period. Patients were more likely to perform finger stick blood glucose tests under the MCO (76.8% vs. 40.7%, P = .001), but did not report that blood glucose was controlled more of the time (P = .332).


CONCLUSIONS
Most patients were satisfied with their MCO care, and most reported that finger stick glucose monitoring increased under the MCO. However, no significant gains in controlling blood sugar were reported. From the perspective of most patients, enrollment in an MCO had positive outcomes and resulted in improved access to diabetes-related health information.
University of Tennessee Health Science Center, Departments of Preventive Medicine and Medicine, 66 N. Pauline, Suite 633, Memphis, TN 38105, USA.
Robin J
RJ
Womeodu
Marshall J
MJ
Graney
Deborah V
DV
Gibson
James E
JE
Bailey
D003920:Diabetes Mellitus / Q000191:economics / Q000523:psychology*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008329:Managed Care Programs / Q000458:organization & administration*; D008484:Medicaid; D008875:Middle Aged; D017060:Patient Satisfaction; D011787:Quality of Health Care; D013714:Tennessee