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Health Serv Res. 2014 Jun;49(3):858-77. doi: 10.1111/1475-6773.12129. Epub 2013 Nov 18.

Do provider service networks result in lower expenditures compared with HMOs or primary care case management in Florida's Medicaid program?

Author information

1
Department of Health Services Research, Management and Policy, College of Public Health and Health Professions, University of Florida, Gainesville, FL.

Abstract

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 HMOs versus provider service networks (PSNs) in the Demonstration was associated with PMPM expenditures.

DATA:

Florida Medicaid claims from two fiscal years prior to implementation of the Demonstration (FY0405, FY0506) and the first four fiscal years after implementation (FY0607-FY0910) 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 HMOs and PSNs.

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 PSNs lowering PMPM expenditures by $7 more than HMOs. 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 PSNs generated slightly greater reductions in expenditures compared to Demonstration HMOs. PSNs appear to be a promising model for delivering care to Medicaid enrollees.

KEYWORDS:

Administrative data uses; Medicaid; health care costs; health care organizations and systems

PMID:
24237112
PMCID:
PMC4231575
DOI:
10.1111/1475-6773.12129
[Indexed for MEDLINE]
Free PMC Article

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