Article

Evaluating Florida's Medicaid Provider Services Network Demonstration

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Abstract

To evaluate the design, development, and implementation of Florida's Medicaid provider service network (PSN) demonstration, and the implications of that demonstration for subsequent Medicaid Reform in Florida. DATA SOURCES, DATA COLLECTION: Organizational analyses were based on archival and enrollment data obtained from Florida's Medicaid program and the South Florida Community Care Network, as well as key informant interviews. Closely related fiscal analyses utilized Medicaid claims data from March 1999 through October 2001 extracted from the Florida Medicaid Management Information System. The organizational analyses reported here were based on a structured case study research design. Almost every aspect of the development of the new organizational form (PSN) took longer and was more difficult than anticipated. Prior organizational experience with insurance functions proved to be an asset. While fiscal analyses indicated that the program saved the state of Florida a significant amount of money, tracking the precise origin of the savings proved to be challenging. By most standards, the PSN program was observed to meet its stated objectives. Based in part on this conclusion, the state chose to extend the use of PSNs within its 2006 Medicaid Reform initiative.

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... The objectives of PSNs are to improve quality of healthcare services and manage Medicaid expenditures efficiently. [1][2][3] There are two different types of PSNs: health system-based PSNs (H-PSNs) and physician-based PSNs (P-PSNs). At the initial stage of PSN implementation, several safety net hospitals and physicians working with these hospitals in South Florida assembled the framework of the delivery network. ...
... At the initial stage of PSN implementation, several safety net hospitals and physicians working with these hospitals in South Florida assembled the framework of the delivery network. 2,4,5 This network was adopted as a health system-based PSNs (H-PSNs). The physician-based PSNs (P-PSNs) were derived from the minority physician network (MPN). ...
... The dataset from the AHCA included Medicaid ID, enrollee name, demographics, county, eligibility status, and health plan name. 2 The study population was a randomly selected sample of beneficiaries from Medicaid member-month and eligibility files to confirm that members were a representative sample from each Medicaid managed care plan (MediPass -Florida primary care case management program, HMOs, and PSNs). 1 Medicaid enrollees in the original reform counties were randomly selected to participate in a 20-minute telephone-based Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey for at least 6 months. The CAHPS survey include ratings of overall healthcare, health plan, primary doctor or nurse, specialty care, and reports of experiences with using a health plan and healthcare services. ...
Article
Two counties in Florida were selected as pilots in 2006 for the Medicaid Demonstration Program. In reform counties, Medicaid enrollees were required to pick a managed care plan; either a Health Maintenance Organization or a Provider Service Network (PSN). PSNs are a form of managed care that provides health care services directly through a provider or network of organizations to a defined population without an intermediary. There are two types of PSNs: Physician-based PSNs and Healthcare system-based PSNs. The objective of this study is to find the differences in enrollees’ satisfaction between two different types of PSNs. To assess the differences in enrollees’ satisfaction between physician-based PSNs and health system-based PSNs over time, this study used difference-in-difference study design with CAHPS data from 2006 to 2008. The study findings showed that, compared to enrollees in physician-based PSNs, health system-based PSN enrollees had higher satisfaction during the post-reform period. However, the trends in satisfaction for enrollees in health system-based PSNs declined at a greater rate relative to the trends for enrollees in physician-based PSNs. Findings from this study may give other states, facing similar decisions to reform their Medicaid managed care system, information to decide whether to adopt a similar plan or to consider other interventions to improve Medicaid beneficiaries’ satisfaction. PSNs are structured similarly to the new accountable care organizations (ACO) models emerging as a result of the Affordable Care Act. Therefore, study findings may be helpful to in improving patient satisfaction with care in ACOs.
... PSN is "a network established or organized and operated by a health care providers or group of affiliated health care providers" [5]. Contrary to HMO, PSN is considered a mean to avoid "middleman" costs because Medicaid pays healthcare providers directly while PSN uses various managed care techniques to control utilization and cost of health care [6]. The Agency for Health Care Administration (AHCA) has primary responsibility for Florida's Medicaid program and has contracted with HMOs on a prepaid fixed monthly rate per member since 1984. ...
... With the MediPass, primary care physicians (PCPs) provide care coordination services and disease management services to MediPass enrollees in return for a small monthly patient management fee (i.e., $2) per enrollee, plus Medicaid reimbursement for services that are rendered. On March 1, 2000, a contract between South Florida Community Care Network and AHCA officially created a Medicaid PSN in Florida [6]. As of February 2012, there are 18 Medicaid HMOs plans in Florida and 7 Medicaid PSNs as of October 2011. ...
Article
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Background The intent of adopting managed care plans is to improve access to health care services while containing costs. To date, there have been a number of studies that examine the relationship between managed care and access to health care. However, the results from previous studies have been inconsistent. Specifically, previous studies did not demonstrate a clear benefit of Medicaid managed care. In this study we have examine whether Medicaid managed care is associated with the probabilities of preventable hospitalizations. This study also analyzes the spillover effect of Medicaid managed care into Medicaid patients in traditional FFS plans and the interaction effects of other patient- and county-level variables on preventable hospitalizations. Methods The study included 254,321 Medicaid patients who were admitted to short-term general hospital in the 67 counties in Florida. Using 2008 hospital inpatient discharge data for working-age adult Medicaid enrollees (18-64 years) in Florida, we conduct multivariate logistic regression analyses to identify possible factors associated with preventable hospitalizations. The first model includes patient- and county-level variables. Then, we add interaction terms between Medicaid HMO and other variables such as race, rurality, market-level factors, and resource for primary care. Results The results show that Medicaid HMO patients are more likely to be hospitalized for ambulatory care sensitive conditions (ACSCs) (OR = 1.30; CI = 1.21, 1.40). We also find that market structure (i.e., competition) is significantly associated with preventable hospitalizations. However, our study does not support that there are spillover effects of Medicaid managed care on preventable hospitalizations for other Medicaid recipients. We find that interactions between Medicaid managed care and race, rurality and market structure are significant. Conclusions The results of our study show that the Medicaid managed care program in Florida was associated with an increase in potentially preventable hospitalizations for Medicaid enrollees. The results suggest that lower capitation rate has been associated with a greater likelihood of preventable hospitalizations for Medicaid managed care patients. Our findings also indicate that increased competition in the Medicaid managed care market has no clear benefit in Medicaid managed care patients.
Article
To determine the impact of Florida's Medicaid Demonstration 4 years post-implementation on per member per month (PMPM) Medicaid expenditures and whether receiving care through HMOs versus provider service networks (PSNs) in the Demonstration was associated with PMPM expenditures. Florida Medicaid claims from two fiscal years prior to implementation of the Demonstration (FY0405, FY0506) and the first four fiscal years after implementation (FY0607-FY0910) from two urban Demonstration counties and two urban non-Demonstration counties. A difference-in-difference approach was used to compare changes in enrollee expenditures before and after implementation of the Demonstration overall and specifically for HMOs and PSNs. Claims data were extracted for enrollees in the Demonstration and non-Demonstration counties and collapsed into monthly amounts (N = 26,819,987 person-months). Among SSI enrollees, the Demonstration resulted in lower increases in PMPM expenditures over time ($40) compared with the non-Demonstration counties ($186), with Demonstration PSNs lowering PMPM expenditures by $7 more than HMOs. Savings were also seen among TANF enrollees but to a lesser extent. The Medicaid Demonstration in Florida appears to result in lower PMPM expenditures. Demonstration PSNs generated slightly greater reductions in expenditures compared to Demonstration HMOs. PSNs appear to be a promising model for delivering care to Medicaid enrollees.
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President Bush's FY 2005 budget proposes converting a wide range of federal pro- grams into block grants. Block grants are fixed sums of money given to state or local governments to support program activities and administration. Compared with other grants, block grants give state and local- level recipients more flexibility in program design and implementation with reduced federal oversight and requirements. Most of Bush's block grant proposals
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This study examines the cost implications of outsourcing Medicaid functions to the private sector. We examine the expenditures for enrollees in three Medicaid primary care case management (PCCM) demonstration projects compared to Florida's PCCM program from February 2002-February 2003. The RAND two-part model was used to analyze the medica expenditures for enrollees in each program. After adjusting for sociodemographic factors and the probability of service use, we found that all three demonstration projects reduced expenditures compared to the PCCM program. The implications from the study are that Medicaid programs may want to consider outsourcing PCCM functions after further studies examine the utilization experience for enrollees in these programs.
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Advances in rheumatologic arthritis health services research continue to be of interest to clinical rheumatologists and arthritis researchers interested in healthcare delivery and policy. Recent studies have shown that a higher incidence of osteoarthritis and functional disability among rural inhabitants influences delivery of arthritis care to rural areas and urban-rural variations in specialist distribution. In the United States, managed care organizations are increasingly dictating who delivers and who receives health care for arthritis. Provision of arthritis care by rheumatologists has become more discretionary and is strongly influenced by a patient's health insurance coverage. Coinciding with this trend, a higher percentage of arthritis care is being shifted to primary care providers. Based on prominent practice pattern variations, generalists have divergent knowledge and beliefs about the value of various arthritis treatments. New therapeutic programs have been proposed to better coordinate efforts between generalists and specialists. Many arthritis patients also seek alterative therapies. Of these, chiropractic care is one of the most common nontraditional therapies. Chiropractic management appears to be as cost-effective as traditional back care in certain settings.
Article
The Medicaid program made a major commitment to managed care during the past decade. Following turbulent early years, the marriage matured and stabilized because managed care models responded well to a number of the states' goals and Medicaid purchasers were willing to make key trade-offs on behalf of their beneficiaries that conformed to the designs of managed care products. The relative tranquility in Medicaid managed care contrasts sharply with turmoil in both the commercial and Medicare sectors. But continuing changes in the managed care marketplace and financial distress in state budgets present new challenges to the strength and durability of this relationship.
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