Funded Projects

Medicaid Managed Care and the Quality of Care for Women and Children: Evaluating a Randomized Trial of Enrollment in a Medicaid-Focused or Commercial Health Insurance Plan

Grantee: Brown University
Principal Investigator: Amal Trivedi
Project Number: R40MC28319
Project Date: 04/01/2015

Abstract

Of the over 50 million women and children enrolled in Medicaid, over 80% are enrolled in a managed care plan. State Medicaid programs rely on two distinct types of managed care plans to insure their enrollees: 1) Medicaid-focused plans, which exclusively or nearly exclusively target the Medicaid population; and 2) commercial health plans, large, predominantly for-profit firms that offer a Medicaid product alongside other private insurance options. Although the role of Medicaid managed care in serving low-income women and children will increase following the Medicaid expansions initiated under the Affordable Care Act (ACA), there remains limited evidence about the impact of managed care on the quality of care delivered to Medicaid enrollees, particularly women and children. Closing this gap in knowledge is critical given the urgent need to improve the quality and outcomes for women and children in the Medicaid program and the potential role of managed care plans in achieving these objectives. This mixed-methods study will determine through a unique, randomized policy experiment the impact of the type of managed care plan on the quality of care provided to women and children enrolled in Medicaid. Our specific aims are: (1) determine which outcomes are targeted by commercial and Medicaid-focused health plans to improve care for women and children, and identify the policies, initiatives and processes implemented to achieve these quality goals; and (2) compare the quality of care for low-income children and women randomly assigned to a Medicaid-dominant or commercial health plan. To attain these goals, we will leverage a novel policy experiment, in which the state of Rhode Island randomly assigned over 6600 Medicaid enrollees to either a commercial insurance plan or a local, Medicaid-focused plan. In Aim 1, we will conduct qualitative interviews with health plan representatives, Medicaid providers, and state policymakers to determine how plans monitor and prioritize measures of quality of care for women and children in the Medicaid population, and implement policies, initiatives and processes to address their quality goals. Using the results of Aim 1, Aim 2 will assess the impact of random assignment to a Medicaid-focused or commercial health plan on widely-used, validated quality indicators for women and children, including ambulatory caresensitive admissions and emergency department visits, use of effective preventive services, wellchild care, and asthma care. We investigate the effectiveness of alternative models of health system organization and financing on the delivery of services to low-income MCH populations (MCHB Strategic Initiative 1); access to health care (MCHB Initiative 2); and the quality of care (MCHB Initiative 3). Our objectives strongly align the MCHB's call for proposals that develop new knowledge on the impact of insurance coverage on health promotion, directly relate to the implementation of the ACA, and correspond to the stated objectives of Healthy People 2020.

Publications

Listed is descending order by year published.

Gadbois EA, Gordon SH, Shield RR, Vivier PM, Trivedi AN. Quality management strategies in Medicaid managed care: perspectives from Medicaid, plans, and providers. Med Care Res Rev 2019 Apr 4 [Epub ahead of print]

Silva GC, Trivedi AN, Gutman R. Developing and evaluating methods to impute race/ethnicity in an incomplete dataset. Health Services and Outcomes Research Methodology. Septemer 2019, Volume 19, Issue 2-3, pp 175-195.

Gordon SH, Gadbois EA, Shield RR, Vivier P, Trivedi AN. Qualitative perspectives of primary care providers who treat Medicaid patients. BMC Health Services Research. 2018 Sep 21;18(1):728.

Gordon SH, Lee Y, Ndumele CD et al. The impact of Medicaid managed care plan type on continuous Medicaid enrollment: a natural experiment. Health Services Research. 2018 Oct 53(5):3770-3789.

Ndumele CD, Schpero WL, Schlesinger MJ, Trivedi AN. Association between health plan exit from Medicaid managed care and quality of care, 2006-2014. JAMA 2017;317(24):2524-31.