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The Expanding Role of Managed Care in the Medicaid Program
States increasingly use managed care for Medicaid enrollees, yet evidence of its impact on healthcare outcomes is mixed. This research studies county-level Medicaid managed care penetration and healthcare outcomes among nonelderly disabled and nondisabled enrollees.
States increasingly use managed care for Medicaid enrollees, yet evidence of its impact on healthcare outcomes is mixed. This research studies county-level Medicaid managed care (MMC) penetration and healthcare outcomes among nonelderly disabled and nondisabled enrollees.
Results for nondisabled adults show that increased penetration is associated with increased probability of an emergency department visit, difficulty seeing a specialist, and unmet need for prescription drugs, and is not associated with reduced expenditures. We find no association between penetration and healthcare outcomes for disabled adults. This suggests that the primary gains from MMC may be administrative simplicity and budget predictability for states rather than reduced expenditures or improved access for individuals.
Read the article: http://urbn.is/1bEiP6m
Source: The Urban Institute
Health Care Utilization and Cost of Diagnostic Testing for Respiratory Infections
September 17th 2025Syndromic reverse transcriptase–polymerase chain reaction tests for respiratory infections were associated with lower health care resource utilization and costs, implicating potential for improved value in patient care.
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AI in Health Care: Balancing Governance, Innovation, and Trust
September 2nd 2025In this conversation with Reuben Daniel, associate vice president of artificial intelligence at UPMC Health Plan, we dive into how UPMC Health Plan builds trust with providers and members, discuss challenges of scaling AI effectively, and hear about concrete examples of AI's positive impact.
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Infertility Coverage Boosts ART Use and Pregnancy Success: Richard A. Brook, MS, MBA
August 26th 2025In this episode, Richard A. Brook, MS, MBA, discusses his study showing that infertility treatment coverage increases assisted reproductive technology (ART) use and improves pregnancy outcomes.
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