Reprinted from MEDICARE ADVANTAGE NEWS, biweekly news and
business strategies about Medicare Advantage plans, product design, marketing,
enrollment, market expansions, CMS audits, and countless federal initiatives in
MA and Medicaid managed care.
By Lauren
Flynn Kelly, Managing Editor
July 13, 2017 Volume 23 Issue 13
Medicaid enrollees and states may experience some temporary
turbulence when managed care organizations choose to leave a state, but a new
study finds that plan exits do not create significant changes in market-level
quality or self-reported patient experience. This information may be useful to
states as they contemplate a future with potentially fixed federal funding that
is essential to GOP efforts to overhaul the Affordable Care Act, the study’s
lead author suggests.
Using CMS enrollment data from 2006-2014 and health plan
performance information from the Healthcare Effectiveness Data and Information
Set and the Consumer Assessment of Healthcare Providers and Systems survey
compiled by the National Committee for Quality Assurance, researchers from
several universities conducted three separate analyses to estimate the link
between a plan exit and health care quality. The retrospective study, published
June 27 in the online Journal of the American Medical Association,
included 366 MCOs, of which 106 exited the Medicaid program during the study
period. Those exits impacted 4.8 million enrollees, or a mean of 606,039
annually.
The frequency of plan exits varied considerably from year to year,
and there was significant geographic variation in the rates of health plan
exits among states, observed the study. For instance, six states had a mean of
more than 10% of their Medicaid managed care recipients who were annually
enrolled in plans that exited, while 10 states experienced no plan exit during
the study period.
“I think we were most surprised by the variation of health plan
exit across states,” remarks Chima Ndumele, Ph.D., lead author with the Dept.
of Health Policy and Management at Yale School of Public Health. “For Medicaid
recipients, it’s shocking to what extent the state you live in is directly
related to the likelihood that you experience the disruption associated with
your insurance plan exiting your market,” he tells AIS Health.
Meanwhile, plans that left their respective markets had lower
performance in quality of care and lower ratings in patient experience than
those that stayed. And plans that exited a state’s market performed
significantly worse prior to exit than those that remained in terms of
preventive care, maternity care and patient experience, with no significant
difference in chronic disease management. Moreover, in the year following a
plan exit, changes in the quality of care experienced across the market were
not statistically significant and most beneficiaries who were impacted by exits
could obtain coverage from a higher quality plan. For example, 78.3% of
available plans in the same county were higher quality based on the preventive
care composite, added the study.
While the paper did not directly look at predictors of plan exits,
those that exited markets generally had fewer enrollees and lower market share,
notes Ndumele, “so presumably they had less of a healthy risk pool of
recipients to withstand the effect of sicker enrollees.” Compared with
nonexiting plans, those that left also tended to have fewer years of
experience.
“States have increasingly moved enrollees to managed care as a
mechanism to reduce costs; however, states should be aware that partnerships
with private managed care companies end frequently, with real potential
disruptions of care for some recipients,” adds Ndumele. “That being said,
health plan turnover in Medicaid doesn’t appear to be entirely bad for markets.
Plans that leave markets perform, on average, poorer across multiple dimensions
of quality than plans that remain.”
On the flipside, if the Medicaid market becomes less attractive to
insurers due to proposed health reforms that include the federal government
spending 35% less on Medicaid by 2036 (see brief, p. 7), “A concern with the
proposed cuts is that when plans leave, there won’t be plans to replace them,
which could have negative implications for competition and quality.”
View an abstract of the JAMA study at http://jamanetwork.com/journals/jama/article-abstract/2633914.
https://aishealth.com/archive/nman071317-05?utm_source=Real%20Magnet&utm_medium=email&utm_campaign=114707534
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