Exploring the Growth of Medicaid Managed Care
27
Congressional Budget Office Association for Public Policy Analysis & Management Fall Research Conference November 2, 2017 Alice Burns, Ben Layton, Noelia Duchovny, and Lyle Nelson Health, Retirement, and Long-Term Analysis Division The information in this presentation is preliminary and is being circulated to stimulate discussion and critical comment as developmental work for analysis for the Congress. Exploring the Growth of Medicaid Managed Care
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Transcript of Exploring the Growth of Medicaid Managed Care
Congressional Budget Office
Association for Public Policy Analysis & ManagementFall Research Conference
November 2, 2017
Alice Burns, Ben Layton, Noelia Duchovny, and Lyle NelsonHealth, Retirement, and Long-Term Analysis Division The information in this presentation is preliminary and is being circulated to stimulate discussion and critical comment as developmental work for analysis for the Congress.
Exploring the Growth of Medicaid Managed Care
1CO N GR ES S IO N A L B UDGE T O F F IC E
Medicaid is a federal–state program that provides health benefits to over 70 million low-income individuals and accounted for $348 billion of federal spending and $205 billion in state spending in fiscal year2015.
2CO N GR ES S IO N A L B UDGE T O F F IC E
States typically use two payment systems: fee-for-service (FFS) and Medicaidmanaged care (MMC).
States may adopt MMC to:
Increase predictability of spending or
Improve coordination of care, which may reduce costs or improve outcomes.
3CO N GR ES S IO N A L B UDGE T O F F IC E
This project aims to improve our understanding of:
Whether MMC is “the predominant delivery system in Medicaid” and
How and why MMC has grown over time.
The project will therefore inform expectations for future growth.
4CO N GR ES S IO N A L B UDGE T O F F IC E
Key to understanding the growth in MMC is understanding the difference between the percentage of Medicaid enrollment in MMC and the percentage of Medicaid spending that is attributed to payments for MMC.
5CO N GR ES S IO N A L B UDGE T O F F IC E
Percentage of Total Medicaid Enrollment and Spending Accounted for by MMC
0%
20%
40%
60%
80%
100%
1999 2001 2003 2005 2007 2009 2011
Enrollment
Spending
6CO N GR ES S IO N A L B UDGE T O F F IC E
A major challenge to understanding the growth of MMC is the variation in state programs and the lack of systematic data.
We constructed and plan to disseminate a new dataset to support comparisons of states’ MMC programs.
7CO N GR ES S IO N A L B UDGE T O F F IC E
Beneficiaries’ Enrollment in and Spending on Medicaid Managed Care
8CO N GR ES S IO N A L B UDGE T O F F IC E
CBO used Medicaid Analytic eXtract data on beneficiaries’ spending and enrollment from 1999 to 2012 (the most recent period for which the data were available).
Analyses included beneficiaries who were eligible for full Medicaid benefits.
9CO N GR ES S IO N A L B UDGE T O F F IC E
Types of Managed Care Organizations (MCOs)
Comprehensive MCOs General Comprehensive Long-Term Services The Program of All-inclusive Care for the Elderly (PACE)
Noncomprehensive MCOs Behavioral Dental Case Management “Other”
10CO N GR ES S IO N A L B UDGE T O F F IC E
Enrollment in Medicaid Payment Systems, 2012Millions of Beneficiaries
6.3
11.8
10.2
6.5
15.0
6.3
1 ComprehensiveMCO only
Comprehensive MCO,multiple MCOs
ComprehensiveMCOs, multipleMCOs, and FFS
1 ComprehensiveMCO and FFS
NoncomprehensiveMCO(s) and FFS
FFS only
11CO N GR ES S IO N A L B UDGE T O F F IC E
Average Monthly Spending on Payments for MMC and FFS, 2012
Payments for MMC
Payments for FFS Medicaid $118
$526
$1,329
$321
$27$439
$553
$1,329
ComprehensiveMMC
Noncomprehensive MMC FFS Only
12CO N GR ES S IO N A L B UDGE T O F F IC E
1 2 1 32
8
23
8
22
32
12
31
6 7
Nonelderly Adults Children Elderly and DisabledBeneficiaries
Dual-EligibleBeneficiaries
Enrollment by Medicaid Eligibility Group, 2012Millions of Beneficiaries
Comprehensive MMC
FFS Only
NoncomprehensiveMMC
13CO N GR ES S IO N A L B UDGE T O F F IC E
Average Monthly Spending on Payments for MMC and FFS, 2012
$175 $117
$1,068 $1,169
$241$125
$534 $233
$416
$242
$1,602
$1,402
Nonelderly Adults Children Elderly and DisabledBeneficiaries
Dual-EligibleBeneficiaries
Payments for MMCPayments for FFS
Medicaid
14CO N GR ES S IO N A L B UDGE T O F F IC E
Percentage of Total Medicaid Enrollment Accounted for by Comprehensive MMC and of Total Spending Accounted for by MMC
0%
25%
50%
75%
1999 2001 2003 2005 2007 2009 2011
Percentage
Nonelderly Adults
Enrollment
Spending
0%
25%
50%
75%
1999 2001 2003 2005 2007 2009 2011
Percentage
Children
Enrollment
Spending
15CO N GR ES S IO N A L B UDGE T O F F IC E
Percentage of Total Medicaid Enrollment Accounted for by Comprehensive MMC and of Total Spending Accounted for by MMC
0%
25%
50%
75%
1999 2001 2003 2005 2007 2009 2011
Percentage
Elderly and Disabled
Enrollment
Spending
0%
25%
50%
75%
1999 2001 2003 2005 2007 2009 2011
Percentage
Dual-Eligible
Enrollment
Spending
16CO N GR ES S IO N A L B UDGE T O F F IC E
Annual Per-Beneficiary FFS Medicaid Spending Among Nonelderly Adults and Children in Comprehensive MMC, 2012
$84 $81
$53$49
$35 $34
Mental/Substance Use
PrescriptionDrugs
Clinic/Outpatient
NonemergencyDental
Other Acute Care InpatientHospital
Total Spending per Beneficiary $2,783Payments for MMC $2,408Payments on FFS Medicaid $374
17CO N GR ES S IO N A L B UDGE T O F F IC E
Annual Per-Beneficiary FFS Medicaid Spending Among Elderly and Disabled and Dual-Eligible Beneficiaries in Comprehensive MMC, 2012
$1,002
$450 $440 $429$385
$261
Home/Community
Services
Mental/Substance Use
Other Acute Care PrescriptionDrugs
Institutional Care InpatientHospital
Total Spending per Beneficiary $14,912Payments for MMC $11,509Payments on FFS Medicaid $3,403
18CO N GR ES S IO N A L B UDGE T O F F IC E
Changes in States’ MMC Programs Between 1999 and 2014
19CO N GR ES S IO N A L B UDGE T O F F IC E
Difference in Percentage of Spending Attributed to Payments for MMC
20CO N GR ES S IO N A L B UDGE T O F F IC E
Number of States With Any Type of MMC by Program Type
45
0 1
41
29
2
GeneralComprehensive
PACE Long-TermServices
16
24
27
8
16
7
12
21
7
Behavioral Dental Transportation CaseManagement
Other
Comprehensive Noncomprehensive
1999
2014
21CO N GR ES S IO N A L B UDGE T O F F IC E
Of States With General Comprehensive MMC, Percentage With Programs That Were Statewide or Regional
47%
62%
83%
32%
Statewide Programs Regional Programs
1999
2014
22CO N GR ES S IO N A L B UDGE T O F F IC E
Of States With General Comprehensive MMC, Percentage That Mandated Enrollment by Eligibility Group
76% 73%
44%
18%
93%88%
76%
41%
Nonelderly Adults Children Elderly and DisabledBeneficiaries
Dual-Eligible Beneficiaries
1999
2014
23CO N GR ES S IO N A L B UDGE T O F F IC E
Of States With General Comprehensive MMC, Percentage That Covered Various Types of Services
100% 98%
73% 71%76%
58%
11%4%
95%90%
78% 78%
68% 66%
Hospital and AcuteCare
Postacute care Prescription Drugs Mental/SubstanceUse
NonemergencyTransportation
NonemergencyDental
Institutional Care Home/CommunityServices
1999
2014
24CO N GR ES S IO N A L B UDGE T O F F IC E
Key Takeaways
25CO N GR ES S IO N A L B UDGE T O F F IC E
By integrating quantitative and qualitative data, CBO developed a more in-depth perspective on the growth of MMC and created a dataset to support future empirical research.
26CO N GR ES S IO N A L B UDGE T O F F IC E
Measurement matters:
MMC growth may be defined in terms of spending or enrollment.
Comprehensive MMC has different levels of comprehensiveness.
Such considerations have significant implications for developing policy analysis and expectations for future growth.
