Managed Medicaid Supplanting Fee-For-Service Model for
Prescriptions; Cost and Quality Goals Yet to be Fully Realized
PARSIPPANY, N.J.--(BUSINESS WIRE)--Nearly half of all Medicaid prescriptions are now being filled through
Managed Medicaid plans, as states switch patients from the
Fee-for-Service model in an effort to improve patient care and curb the
growth of healthcare costs, according to a new IMS Institute for
Healthcare Informatics report. The study, Shift from Fee-for-Service
to Managed Medicaid: What is the Impact on Patient Care?, which is
being presented today at the Academy of Managed Care Pharmacy Annual
Meeting in San Diego, CA, examines prescription drug utilization in four
states that have experienced a dramatic shift to Managed Medicaid plans
since 2011.
“Managed Medicaid is seen by many states as a way to deliver better
preventive care at a lower cost, and recent actions to reduce use of
Fee-for-Service plans has been significant”
The IMS Institute report, which focuses on Kentucky, New Jersey, New
York and Ohio, compares changes in the use of antipsychotic, respiratory
and diabetes medications between patients who switched to Managed
Medicaid plans and those who remain in Fee-for-Service plans. While
early signs indicate that shifting Medicaid beneficiaries to Managed
Medicaid programs is affecting some care received by patients, the lack
of consistent and measurable change suggests that states’ efforts to
bring better care at lower costs to their Medicaid beneficiaries has yet
to be fully realized.
“Managed Medicaid is seen by many states as a way to deliver better
preventive care at a lower cost, and recent actions to reduce use of
Fee-for-Service plans has been significant,” said Murray Aitken,
executive director, IMS Institute for Healthcare Informatics. “While it
is still early days, our research reveals some important signs of
impact.”
Among the report’s findings:
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Greater use in all states analyzed of antipsychotic generics, when
available. Patients in Managed Medicaid plans are much more likely
to use generic antipsychotic drugs than those in Fee-for-Service
plans. Generic utilization rates in the four states studied are
between 3 percent and 14 percent higher for patients in Managed
Medicaid plans.
-
Increased use of diabetes medications in New York. Patients who
switched to Managed Medicaid plans in New York received 5 percent more
prescriptions for diabetes conditions, including 13 percent greater
use of metformin, the most commonly used diabetes treatment.
-
Greater use of respiratory medications in Kentucky. Patients
who switched to Managed Medicaid plans in Kentucky increased their
average number of prescriptions for respiratory conditions by 5
percent, compared with a 1 percent increase among patients in Ohio and
New Jersey.
-
Negligible impact on care for many patients. Little or no
change was experienced by many patients who switched to Managed
Medicaid plans, or they experienced changes consistent with those who
remained in Fee-for-Service plans. In New Jersey, for example, average
diabetes prescription use per patient declined by 2 percent over the
period analyzed for both Fee-for-Service and Managed Medicaid plans.
Use of antipsychotics in Ohio trended similarly for patients in both
types of plans, with each declining by 1 percent.
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Significant variations remain in Medicaid patient care across
states and disease areas. Variations in patient care reflecting
longstanding differences in clinical practice, Medicaid program design
and patient profiles persist. For example, in New Jersey, average use
of antipsychotics per Fee-for-Service Medicaid patient is 40 percent
lower than in the other states studied, while use of respiratory
medicines by Managed Medicaid plan participants is 40 percent higher.
“The Academy of Managed Care Pharmacy is encouraged to see the positive
results of the IMS Institute for Healthcare Informatics study on
patients receiving care through Managed Medicaid programs,” said Edith
A. Rosato, RPh, IOM, CEO of the Academy of Managed Care Pharmacy. “Given
the variability in state programs, Managed Medicaid plans will need to
be continually evaluated. Initial findings suggest that patients could
be better managed in these programs, particularly when the drug benefit
is carved into a state’s managed care plan rather than maintained in a
Fee-for-Service program.”
Added Aitken, “As states take on more responsibility with expanded
Medicaid enrollment and management of exchanges in 2014 under the
Affordable Care Act, their direct and indirect impact on patient care
will be subject to closer scrutiny. Measuring and assessing the
consequences of their actions on patient care will become more vital to
this critical healthcare program.”
The full report is available at www.theimsinstitute.org.
The study was produced independently as a public service, without
industry or government funding.
About the IMS Institute for Healthcare Informatics
The IMS Institute for Healthcare Informatics provides key policy setters
and decision makers in the global health sector with unique and
transformational insights into healthcare dynamics derived from granular
analysis of information. It is a research-driven entity with a worldwide
reach that collaborates with external healthcare experts from across
academia and the public and private sectors to objectively apply IMS’s
proprietary global information and analytical assets. More information
about the IMS Institute can be found at: http://www.theimsinstitute.org.
About IMS Health
IMS Health is a leading worldwide provider of information, technology,
and services dedicated to making healthcare perform better. With a
global technology infrastructure and unique combination of real-world
evidence, advanced analytics and proprietary software platforms, IMS
Health connects knowledge across all aspects of healthcare to help
clients improve patient outcomes and operate more efficiently. The
company’s expert resources draw on data from nearly 100,000 suppliers,
and on insights from 39 billion healthcare transactions processed
annually, to serve more than 5,000 healthcare clients globally.
Customers include pharmaceutical, medical device and consumer health
manufacturers and distributors, providers, payers, government agencies,
policymakers, researchers and the financial community. Additional
information is available at www.imshealth.com.
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