Question

Case 6: Managed Care

BACKGROUND

Examining access to care takes on heightened importance as enrollment grows in Medicaid managed care programs. Under the Patient Protection and Affordable Care Act, states can opt to expand Medicaid eligibility, and even states that have not expanded eligibility have seen increases in enrollment. Most states provide some of their Medicaid services—if not all of them—through managed care. The Office of Inspector General received a congressional request to evaluate the adequacy of access to care for enrollees in managed care. This report determines the extent to which providers offer appointments to enrollees and the timeliness of these appointments. A companion report issued earlier this year, State Standards for Access To Care in Medicaid Managed Care, OEI-02-11-00320, found that state standards for access to care vary, and that they are often not specific to certain provider types or to areas of the state. Additionally, states have different strategies to assess compliance with access standards.

HOW WE DID THIS STUDY

We based this study on an assessment of availability of Medicaid managed care providers. The assessment included calls to a stratified random sample of 1,800 primary care providers and specialists to assess availability and timeliness of appointments for enrollees.

WHAT WE FOUND

We found that slightly more than half of providers could not offer appointments to enrollees. Notably, 35 percent could not be found at the location listed by the plan, and another 8 percent were at the location but said that they were not participating in the plan. An additional 8 percent were not accepting new patients. Among the providers who offered appointments, the median wait time was 2 weeks. However, over a quarter had wait times of more than 1 month, and 10 percent had wait times longer than 2 months. Finally, primary care providers were less likely to offer an appointment than specialists; however, specialists tended to have longer wait times.

Source: United States Department of Health and Human Services. (2014). Access to care: Provider availability in Medicaid managed care. Retrieved from http://oig.hhs.gov/oei/reports/oei-02-13-00670.pdf (Links to an external site.)

QUESTIONS

1. As a healthcare administrator what recommendations would you implement from the findings in this plan with regards to access for the Medicaid managed care enrollee?

Answer 1

Providing appropriate and well defined   medical care is one of the biggest implement done by any health administrator to their country.

1-Firstly a well systematically arrangement of plan should   be created so that any kind of problem face by the people could be minimize.

2-There should be a proper information and mentioned of advantages   to the people who are not participating in this plan.

3- there should be a time management so that waiting of people from a month would reduced.

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