Managed Care v. Fee For Service

Issue Defined

"To provide effective and efficient delivery systems designed to provide better access, consumer choice, and economy, congruence of a quality of life in the least restrictive setting to Medicaid recipients now and in the future."

Recommendations

Transition the long-term care users from FFS models to comprehensive risk-based managed care models.

A recent study illustrates the effectiveness of managed care over a fee-for-service system or special needs plan: Beneficiaries in managed care were less likely than beneficiaries in other delivery systems to experience inpatient admissions and emergency room visits, but more likely to participate in preventative procedures such as breast cancer and cholesterol screenings.

Savings Outlook

Integrate medical services with community-based services to facilitate the "right services at the right time," ensuring person-centered, comprehensive, coordination of services across the spectrum of available services.