Do Medicaid Managed Care Structures Succeed in Coordinating Care?​​

Rishi Agrawal, MD, MPH, a hospital-based medicine specialist at Lurie Children’s, has been studying medically complex patients for years. “Children with medical complexity can have multiple health issues, chronic conditions, or other issues that make it difficult to manage their diseases. Good care coordination is extremely important for these patients to remain as healthy as possible,” he explains.

Agrawal is the lead author on a study that evaluated the relationships between enrollment in 2 Medicaid managed care (MMC) structures – primary care case management (PCCM) and health maintenance organization (HMO) – and access to and receipt of care coordination by children. The study was published in Pediatrics.

Enrollment in Medicaid has increased significantly in recent years, and children are part of this trend. MMC is used by states to control costs and increase access to services. Care coordination is a key metric in MMC evaluation because it drives much of the proposed cost savings and may be associated with improved health outcomes and utilization. However, it is unknown if MMC actually delivers on its promise to coordinate care for children. 

Agrawal’s biggest takeaway from the study is that the form of MMC made a difference in terms of care coordination. He says, “While the PCCM demonstrated both increased access to and receipt of care coordination, the HMO structure was associated with lower access to and receipt of care coordination.

“Our results demonstrate a significant, national-level correlation between the form of MMC used by states and the odds that a child living within that state will have access to adequate care coordination and that he or she will receive care coordination when needed. This is especially important to the children with medical complexity whom I serve,” he continues.

Agrawal points out that the study wasn’t designed to capture specific reasons for these disparities. “We don’t know why there are differences between these two structures. We also don’t have answers yet to a critical question – Does access to and receipt of care coordination actually improve the health of children who receive it? We hope to expand on our studies with this objective in mind.” One thing he is confident about, though. “Primary care case management seems to be a better option if we are interested in coordinating care. States should consider this when structuring their Medicaid programs.”

This study was conducted with researchers from Northwestern University, the University of Colorado and Lurie Children’s. Rishi Agrawal, MD, MPH, is an attending physician in Hospital-Based Medicine at Lurie Children’s and Assistant Professor of Pediatrics​ at Northwestern University Feinberg School of Medicine. 

To cite this article: Gilchrist-Scott DH, Feinstein JA, Agrawal R. Medicaid Managed Care Structures and Care Coordination. Pediatrics. 2017;140(3):e20163820​