Apr 18, 2013 • 25M

Joan Alker Discusses What's Known About the Quality of Care Provided by For-Profit Medicaid Managed Care Plans (April 18, 2013)

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Appears in this episode

David Introcaso, Ph.D.
Podcast interviews with health policy experts on timely subjects. The Healthcare Policy Podcast website features audio interviews with healthcare policy experts on timely topics. An online public forum routinely presenting expert healthcare policy analysis and comment is lacking. While other healthcare policy website programming exists, these typically present vested interest viewpoints or do not combine informed policy analysis with political insight or acumen. Since healthcare policy issues are typically complex, clear, reasoned, dispassionate discussion is required. These podcasts will attempt to fill this void. Among other topics this podcast will address: •Implementation of the Affordable Care Act •Other federal Medicare and state Medicaid health care issues •Federal health care regulatory oversight, moreover CMS and the FDA •Healthcare research •Private sector healthcare delivery reforms including access, reimbursement and quality issues •Public health issues including the social determinates of health Listeners are welcomed to share their program comments and suggest programming ideas. Comments made by the interviewees are strictly their own and do not represent those of their affiliated organization/s.
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It's estimated the Affordable Care Act will add another 16-17 million lives to the 60 million Americans already receiving Medicaid.  Of these current 60 million Medicaid enrollees, two-thirds receive their health care via managed care companies and over half of Medicaid managed care enrollees are in for profit plans.  Concerning the quality of care for profit plans deliver, a 2011 study published by the Commonwealth Fund found for profit Medicaid plans did significantly worse than non profit plans at ensuring members receive preventive care and managing members chronic disease.  Also too, for profit plans had comparatively higer administration costs than non profit plans.

Ms. Alker begins this 24-minute interview discussing reasons for ever-growing Medicaid managed care plan enrollment and the issue of access to, or provider participation in, Medicaid and in Medicaid managed care plans.  She assesses the state of quality data collection and explains why data is generally lacking, spotty and/or not uniformly collected.  She makes comment on for profit  interest in expanding to cover additional Medicaid sub-populations, what relevant ACA reforms promise, the challenges and opportunities for reducing costs since the Medicaid program as already an efficient payer, findings from her recent study of a five-county managed care demonstration in Florida and lastly provides comment on the recent decision in Arkansas to use federal Medicaid subsidies to purchase insurance in 2014 via their state exchange for citizens otherwise eligible for Medicaid under the ACA's expanded coverage provision.             

Ms. Joan Alker is the Co-Executive Director at the Center for Children and Families (CCF) and for the past ten years a Research Associate Professor at the Georgetown University Health Policy Institute.  Her work focuses on health coverage for low-income children and families, with an emphasis on Medicaid, the Children’s Health Insurance Program (CHIP) and the Affordable Care Act (ACA).  She has authored numerous reports and studies on a range of issues including Medicaid waivers, child and family coverage, premium assistance and is the principal investigator of a multi-year study on Florida’s Medicaid program.  Ms. Alker holds a Master of Philosophy in politics from St. Antony’s College, Oxford University and a Bachelor of Arts with honors in political science from Bryn Mawr College.