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Do Provider Service Networks Result in Lower Expenditures Compared with HMO s or Primary Care Case Management in Florida's Medicaid Program?
Author(s) -
Harman Jeffrey S.,
Hall Allyson G.,
Lemak Christy H.,
Duncan R. Paul
Publication year - 2014
Publication title -
health services research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.706
H-Index - 121
eISSN - 1475-6773
pISSN - 0017-9124
DOI - 10.1111/1475-6773.12129
Subject(s) - medicaid , medicine , primary care , medicaid managed care , postal service , family medicine , health care , economic growth , public administration , political science , economics
Objective To determine the impact of Florida's Medicaid Demonstration 4 years post‐implementation on per member per month ( PMPM ) Medicaid expenditures and whether receiving care through HMO s versus provider service networks ( PSN s) in the Demonstration was associated with PMPM expenditures. Data Florida Medicaid claims from two fiscal years prior to implementation of the Demonstration ( FY 0405, FY 0506) and the first four fiscal years after implementation ( FY 0607‐ FY 0910) from two urban Demonstration counties and two urban non‐Demonstration counties. Study Design A difference‐in‐difference approach was used to compare changes in enrollee expenditures before and after implementation of the Demonstration overall and specifically for HMO s and PSN s. Data Extraction Claims data were extracted for enrollees in the Demonstration and non‐Demonstration counties and collapsed into monthly amounts ( N = 26,819,987 person‐months). Principal Findings Among SSI enrollees, the Demonstration resulted in lower increases in PMPM expenditures over time ($40) compared with the non‐Demonstration counties ($186), with Demonstration PSN s lowering PMPM expenditures by $7 more than HMO s. Savings were also seen among TANF enrollees but to a lesser extent. Conclusions The Medicaid Demonstration in Florida appears to result in lower PMPM expenditures. Demonstration PSN s generated slightly greater reductions in expenditures compared to Demonstration HMO s. PSN s appear to be a promising model for delivering care to Medicaid enrollees.