reports

Quality of care for Medicaid and privately insured children in a commercial insurance plan

Richmond, VA, USA: Virginia Commonwealth University (doctoral dissertation).

Virginia Commonwealth University, Richmond, VA, USA

The central thesis of this study is that exposure to the managed care environment can eliminate or reduce disparities within and between Medicaid and privately insured populations for a common chronic disease such as pediatric asthma. The objectives of this study are to measure utilization levels, access to care measures, and utilization-based quality of care (QOC) measures using administrative claims data from a single managed care organization (MCO) that offers coverage for medical care services through the publicly funded Medicaid program and an employer sponsored private health insurance plan in a single state. The proponents of managed care have touted it not only for cost savings through utilization control but also for providing an incentive for the MCO to change the focus of the medical care system from a short-term, problem focused approach typified by the medical model for acute care, to one that emphasizes long term management of chronic conditions through the use of evidence-based guidelines in an attempt to meld effective care with efficient care. The goals of the study are to identify characteristics and services of an MCO that may be associated with changes in QOC over time in both the Medicaid and privately insured population.