Beneficiaries Poorly Informed About Medicaid Managed Care

Complex Rules, Lack Of Education Present Huge Obstacles

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As state and federal regulations force more and more of the roughly 31 million Americans in the Medicaid system to enroll in managed care, a new study reveals that officials often fail to provide the information that beneficiaries need to select an appropriate plan and navigate the managed care system. Managed care is designed to save money by reducing inappropriate and costly care and by emphasizing preventive care. To be effective, the approach requires patients to take an active role. "Medicaid beneficiaries need to become informed consumers of health services, seeking preventive and primary care early rather than waiting until conditions require emergency care," said Karen Davis, president of The Commonwealth Fund, which funded the study. "They need to understand managed care, its rules, and how to advocate effectively for needed care for themselves and family members." Educating Medicaid Beneficiaries About Managed Care: Approaches in 13 Cities examines data from 13 American cities with a range of Medicaid populations: Chicago, Detroit, the District of Columbia, Houston, Los Angeles, Memphis, Miami, Newark, New York City, Philadelphia, Phoenix, Portland, and Seattle. The full report is available on the Internet at http://www.commonwealthfund.org/programs/ quality_kaplan_educat_fr_380.pdf. From 1991 to 1998 the percentage of the Medicaid population enrolled in managed care surged from 10 percent to 54 percent. According to the report, the enrollment process is an ideal time to begin explaining the elements of managed care to beneficiaries. But education efforts are inconsistent and often leave members in the dark about health plan quality and even which doctors or hospitals participate in a particular plan. "If they are to become knowledgeable and effective managed care consumers, Medicaid beneficiaries need to understand how to choose a plan and how to navigate the system," said Sue Kaplan, principal author of the report. "The system is complex and constantly changing, and Medicaid officials haven't yet figured out how to effectively communicate with beneficiaries, whose often low educational and literacy levels create additional challenges." The top criterion beneficiaries use to select a plan is their current physician's affiliation, the report says. None of the study sites in the 13 cities-representing one-third of the nation's Medicaid managed care population-compares plans on quality measures or makes accurate and current provider information easily available. Only one city in the study furnishes data on customer satisfaction and few have any educational expertise in enrollment or outreach. The result is that existing educational materials are poorly suited to beneficiaries' needs and program officials don't know how to reach beneficiaries or assess their own education efforts. While there is wide agreement among front-line officials that a more aggressive education effort is badly needed, there is no money to pay for it, the report says. Low education and literacy levels among beneficiaries, combined with the complexity of the system, present a daunting challenge for policymakers seeking to develop programs to teach beneficiaries to understand, use, and ultimately benefit from Medicaid managed care. Aside from learning how to choose a plan and navigate the managed care system, Medicaid beneficiaries must also learn to develop and maintain healthy habits, the authors say. In conclusion, the authors call for a continuing, comprehensive education strategy outlining a series of clear and focused messages tailored to the needs of people enrolled in Medicaid managed care. None of the cities examined in the report has such a strategy in place. Educating Medicaid Beneficiaries About Managed Care: Approaches in 13 Cities was written by Sue Kaplan, Jessica Greene, and Susan Ghanbarpour of New York University, and Chris Molnar and Abby Bernstein of the Community Service Society of New York.

Publication Details

Publication Date: May 17, 2000

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