Medicaid managed care: Costs, access, and quality of care
A study of existing research on Medicaid managed care suggests that officials in Kansas and across the country may be overestimating the extent to which it can save money and lead to better health outcomes.
Michael Sparer is a professor at Columbia University’s Mailman School of Public Health. He recently completed a comprehensive review of the research done on Medicaid managed care for the Robert Wood Johnson Foundation. He concluded in a report published in September 2012, that managed care initiatives have not substantially reduced Medicaid costs nor improved the quality of care.
“The peer-reviewed literature on the cost implications of Medicaid managed care is quite thin, especially given the anecdotal claims of cost savings by policymakers at both the state and federal levels,” Sparer wrote.
While a few studies found modest savings, Sparer said that virtually all the others he examined showed that Medicaid managed care initiatives were either cost neutral or “end up costing more than traditional fee-for-service programs.”
Many of the state-specific studies that showed cost savings and the report that summarized them were done by consulting firms on behalf of health plan associations, Sparer noted in the report.
Kansas Medicaid officials have estimated that Gov. Sam Brownback’s KanCare managed care initiative will reduce projected increases in Medicaid spending by at least $1 billion over the next five years. Currently, the program costs approximately $3.2 billion a year. The state is responsible for about $1.3 billion of that cost, the federal government the rest.
In an interview with the KHI News Service, Sparer said some savings are possible given that the state is seeking to start managing the care provided to its most expensive Medicaid populations – the elderly, disabled and chronically ill. But the existing evidence indicates policymakers in Kansas and elsewhere should temper their expectations, he said.
“State after state is promising significant decreases and I’m very skeptical that managed care is going to save the kind of money that people are talking about,” Sparer said. “It costs money to take care of older, sicker people and we’ve been sort of getting by on the cheap in a low-cost program like Medicaid. So, it’s hard to say we’re both going to do right by these people and save money at the same time.”
States that have achieved what Sparer refers to as “modest savings” in his report have done so in part by cutting provider rates, something that Kansas officials have vowed not to do. The contracts the state negotiated with three Medicaid managed care companies prohibit the companies from reducing provider rates in order to meet their cost-saving targets.
In addition to saving money, Brownback and others in his administration have said they expect KanCare to improve the quality of care provided to the approximately 380,000 Kansans on Medicaid, particularly for those high-cost, high-need populations.
Setting improved quality as a twin objective to reduced costs is laudable but may not be realistic, Sparer said.
“There are trade-offs between cost, access and quality,” he said. “If you are actually going to improve access so that you can improve quality – that could cost more money. I think there is a lot of evidence that suggests managed care could be a good way to go but it’s not magic. So, I think you really do have to be cautious in your estimates of how it’s going to play out.”
KHI News Service coverage of KanCare
→ Hutchinson Clinic's letter throws a curve to KanCare open enrollment (1/28/14)
→ National Disability Council again urges CMS to hold off on Kansas DD carve-in (1/14/14)
→ DD carve-in not approved for Jan. 1 launch (12/27/13)
→ National Council on Disability urges one-year delay of KanCare DD carve-in (12/13/13)
→ KDADS chief describes lessons learned with KanCare (12/5/13)
→ Other states watching Kansas as it implements ‘unprecedented’ Medicaid model (12/5/13)
→ KanCare reimbursement problems continue for providers (11/25/13)
→ Kansas dental program for children on hold because of KanCare MCO (11/11/13)
→ Kansas Medicaid providers complain to oversight committee (10/7/13)
→ Wichita hospital execs describe problems with KanCare (8/29/13)
→ KanCare to adopt “health home” model for treating mentally ill (7/22/13)
→ Kentucky’s rush into Medicaid managed care: A cautionary tale for other states (7/18/13)
→ DD groups largely reconciled to KanCare carve-in (7/15/13)
→ Advocates urge more government oversight of Medicaid managed care (7/8/13)
→ Independent pharmacists push for KanCare contract enforcement (7/1/13)
→ Payroll agents for the disabled on Medicaid say they are struggling under KanCare (6/3/13)
→ Personal Care Attendants: KanCare's unheralded workers (5/20/13)
→ House GOP leaders pen letter backing DD supports in KanCare (5/17/13)
→ More than 1,000 rally at Statehouse for DD carve-out (5/8/13)
→ Nothing to be done about coverage gap in states not expanding Medicaid, feds say (4/29/13)
→ As KanCare continuity of care period ends, problems persist; legislators starting to hear about it (4/8/13)
→ Advocates raise concerns over possible reductions in KanCare services (3/28/13)
→ Conferees agree on KanCare oversight committee (3/28/13)
→ DD advocates push to extend KanCare "carve-out" (3/20/13)
→ Safety-net clinics struggling with KanCare (3/4/13)
→ Major medical provider groups ask for longer KanCare transition (2/13/13)
→ Lawmakers and providers assess KanCare transition (1/28/13)
→ Five-part series: "Lower cost and better care: Can KanCare deliver?" (1/14/13)
→ Independence of KanCare ombudsman questioned (1/7/13)
→ KanCare special terms and conditions spelled out by CMS in a document (12/28/12)
→ KanCare workforce shift hampering local agencies (12/10/12)
→ Governor announces KanCare approval by feds (12/7/12)
→ More KanCare implementation details outlined (12/3/12)
→ Federal officials say they hope to act soon on KanCare waiver request (11/28/12)
→ New KanCare info included on state website (11/20/12)
→ Groups call for KanCare delay (11/8/12)
→ Go/no-go date looms this week for KanCare (10/15/12)
→ KanCare benefit packages outlined (9/26/12)
→ Provider groups nervous about lack of KanCare details (9/13/12)
→ KanCare Confidential (9/10/12)
→ KanCare contracts awarded (6/27/12)
→ KanCare plan panned again at public hearing (6/20/12)
→ Wichita KanCare forum draws more than 200 (6/19/12)
→ Medicaid makeover: Can Kansas learn from Kentucky? (6/11/12)
→ Hundreds protest inclusion of disability services in KanCare (4/25/12)
→ Counties weighing in on KanCare (4/9/12)
→ Hospital administrator to chair KanCare Advisory Council (3/29/12)
→ Brownback Medicaid makeover an “ambitious” plan (3/28/12)
→ KanCare bidders heavily courting Medicaid providers (3/19/12)
→ Legislators push to delay KanCare start (3/7/12)
→ Brownback announces managed care for all in Medicaid (11/8/11)
→ Kansas Medicaid makeover in the works (3/7/11)
→ Full Medicaid and KanCare coverage
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