Shift to Managed Medicaid shows some effects on patient care, but overall effect unclear, study finds

Shift may boost use of generics in some cases

PARSIPPANY, N.J. — A growing number of patients on Medicaid are filling their prescriptions through Managed Medicaid plans instead of the fee-for-service model as states switch them over in an effort to improve patient care and cut healthcare costs, but the effects remain unclear, according to a new study.

The study, "Shift from Fee-for-Service to Managed Medicaid: What is the Impact on Patient Care?," by the IMS Institute of Healthcare Informatics, a division of IMS Health, focused on Kentucky, New Jersey, New York and Ohio, finding that nearly half of all Medicaid patients are on Managed Medicaid plans; the four states were chosen because they had experienced a dramatic shift to Managed Medicaid plans since 2011. IMS said the lack of consistent and measurable change could mean that efforts to improve care and lower costs for Medicaid beneficiaries had yet to be fully realized despite early signs that the shift was affecting some care.

"Managed Medicaid is seen by many states as a way to deliver better preventive care at a lower cost, and recent actions to reduce use of fee-for-service plans has been significant," IMS Institute for Healthcare Informatics executive director Murray Aitken said. "While it is still early days, our research reveals some important signs of impact."

Findings in the report included greater use of generic antipsychotic drugs in all the states analyzed when those drugs were available, meaning patients in Managed Medicaid plans were likely to use generic antipsychotics at a rate 3% to 14% higher than those in fee-for-service plans.

Drugs for certain diseases were prescribed at higher rates in some states than in others. In New York, patients who switched to Managed Medicaid plans received 5% more prescriptions for diabetes conditions, including 13% greater use of the common diabetes drug metformin. In Kentucky, Managed Medicaid patients had a 5% higher rate of prescriptions for respiratory drugs, compared with a 1% increase among patients in Ohio and New Jersey.

Still, the study found little or no change among patients who switched to Managed Medicaid plans, or found that they experienced changes consistent with those who stayed in fee-for-service plans. In New Jersey, the average diabetes prescription use per patient declined 2% for patients in both plans, while use of antipsychotics in Ohio declined by 1% for both groups.

The study also found significant variations in Medicaid patient access across states and disease areas, reflecting differences in clinical practice, Medicaid program design and patient profiles. In New Jersey, use of antipsychotics for fee-for-service patients is 40% lower than in the other states, while Managed Medicaid patients show 40% greater use of respiratory medicines.

The study was presented at the Academy of Managed Care Pharmacy's annual meeting in San Diego last week.


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