Bridging Disciplinary Boundaries (January 11 - 14, 2007)

Purpose: To compare the experiences of Medicaid and privately insured populations with managed care health plans. In an effort to curb the rising costs of health care, many states are turning to managed care health plans. Unlike the privately insured populations, in the traditional system of health care Medicaid recipients face obstacles to accessing needed medical services due to inadequate provider participation in the Medicaid program. Managed care health plans offer Medicaid recipients guaranteed access to comprehensive health care services. Methods: Data for this study were obtained from the National CAHPS® Benchmarking data base. The Consumer Assessment of Health Plans (CAHPS®) survey instrument was designed by a multi-disciplinary team of researchers to help consumers assess the quality of health care plans from their perspective. Thus, the questions aim to capture the personal experiences of patients with plans and providers, such as, “In the last 6 months, how often did office staff at a doctor's office or clinic treat you with courtesy and respect?” The design of the instrument permits comparisons across different population groups. Sample size (Medicaid 1,350 and privately insured 1,100) and data collection protocol (3 questionnaires, 2 reminders OR 2 questionnaires, 2 reminders, and 3 telephone attempts) were determined by the National Committee for Quality Assurance (NCQA) certification guidelines. Data were analyzed using two separate structural equation models for the Medicaid and commercially insured populations. The two models consist of six latent variables with multiple indicators for each variable. First, confirmatory factor analyses were conducted for each of the six latent variables. Second, the quality of health plan latent variable was regressed on latent variables health status, experience with personal doctor, experience with specialist, experience receiving care, and experience with health plan. Chi-square, CFI, RMSEA, and inspection of residuals determined the fit of both the measurement and structural models. Results: Factor analysis confirmed the multidimensionality of latent variables: quality of health plan (4 indicators), health status (5 indicators), experience with personal doctor (2 indicators), experience with specialist (2 indicators), experience receiving care (10 indicators), and experience with health plan (3 indicators). Comparison of structured models revealed differences in the perceived quality of health plans. Medicaid recipients rated the quality of their health plans and experiences with managed care health providers more favorably than the privately insured consumers. Implications for practice and policy: Results confirm that for Medicaid recipients, managed care health plans with comprehensive health care services and guaranteed access to providers offer a viable alternative to the traditional system of health care. Social workers can work with legislators, health care providers, and the health insurance industry, to encourage particiaption of managed care health plans in providing services to the Medicaid population. Similarly, in areas where managed care health plans are not a feasible option due to small population sizes, social workers can work with other disciplines in increasing accessibility to comprehensive health care services for Medicaid clients.