April 5th, 2013
The recent moves by states to bring their Medicaid prescription drug benefits under managed Medicaid plans has fully taken root: the percentage of Medicaid prescriptions filled under managed Medicaid plans jumped from 19 percent in September 2011 to 46 percent in June 2012. As yet, the impact this might be having on patient care has not been examined. While it is early days to see the impact on health outcomes and whether better preventive services are being provided at lower cost, any changes in the utilization of prescription drugs can be an early indicator of longer term impact.
At the IMS Institute for Healthcare Informatics, we have looked at four states — Kentucky, New Jersey, New York and Ohio — and compared changes in the use of anti-psychotic, respiratory and diabetes medications between patients who switched to managed Medicaid coverage and those who remained in fee for service. Although this is a limited-scale review, we thought this could be a useful contribution at a time when state (and federal) decision-makers are crafting plans that will have important long-term impacts on many Americans from 2014 on.
While our analysis shows there are early signs indicating a change in care received by patients, the lack of consistent measureable change suggests that states’ efforts to bring better care at lower costs to their Medicaid beneficiaries has yet to be fully realized.
Among the report’s findings:
- Greater use in all states analyzed of antipsychotic generics, when available. Patients in managed Medicaid plans are much more likely to use generic antipsychotic drugs than those in fee-for-service plans. Generic utilization rates in the four states studied are between 3 percent and 14 percent higher for patients in managed Medicaid plans.
- Increased use of diabetes medications in New York. Patients who switched to managed Medicaid plans in New York received 5 percent more prescriptions for diabetes conditions, including 13 percent greater use of metformin, the most commonly used diabetes treatment.
- Greater use of respiratory medications in Kentucky. Patients who switched to managed Medicaid plans in Kentucky increased their average number of prescriptions for respiratory conditions by 5 percent, compared with a 1 percent increase among patients in Ohio and New Jersey.
- Negligible impact on care for many patients. Little or no change was experienced by many patients who switched to managed Medicaid plans, or they experienced changes consistent with those who remained in fee-for-service plans. In New Jersey, for example, average diabetes prescription use per patient declined by 2 percent over the period analyzed for both Fee-for-Service and Managed Medicaid plans. Use of antipsychotics in Ohio trended similarly for patients in both types of plans, with each declining by 1 percent.
- Significant variations remain in Medicaid patient care across states and disease areas. Variations in patient care reflecting longstanding differences in clinical practice, Medicaid program design, and patient profiles persist. For example, in New Jersey, average use of antipsychotics per fee-for-service Medicaid patient is 40 percent lower than in the other states studied, while use of respiratory medicines by managed Medicaid plan participants is 40 percent higher.
The report suggests further analysis is needed to examine the impact on health outcomes and overall Medicaid program costs, and to determine if the goals of states are being achieved. Moreover, as Medicaid programs are poised to expand in 2014, understanding the direct and indirect impact of managed Medicaid will be critical. Establishing measurable goals and monitoring progress among Medicaid beneficiaries should be an urgent priority for states.
The report was developed by the IMS Institute for Healthcare Informatics as a public service without industry or government funding.Email This Post Print This Post
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