In 1999, Medicaid, Commercial Plans Provided Good Access for Children, But Adolescents Faced Barriers, Report Finds

While managed care plans covering Medicaid beneficiaries and the commercially insured "often provide[d] good care to young children" in 1999, they performed "poorly" in providing health care to adolescents, according to a report released Feb. 27 by The Commonwealth Fund (The Commonwealth Fund release, 2/28). The report, "The APHSA Medicaid HEDIS Database Project: Report for the Third Project Year," uses information maintained by the National Committee for Quality Assurance under a contract with the American Public Human Services Association. The database contains Health Plan Employer Data and Information Set scores for managed care plans (Partridge, "The APHSA Medicaid HEDIS Database Project: Report for the Third Project Year," December 2001). HEDIS includes performance measures for managed care plans on a variety of benchmarks, including rate of beneficiaries receiving immunizations, primary care visits and prenatal checkups, and also includes a consumer survey on quality and access to care (NCQA Web site). The Commonwealth Fund report examines 167 managed care plans in 31 states and Puerto Rico that covered almost seven million Medicaid beneficiaries in 1999, about 56% of the total Medicaid beneficiaries enrolled in a managed care plan at the time. The report shows that managed care plans in 1999 overall scored particularly well on children's access to primary care providers. Medicaid plans had a mean score of 82.1% for percentage of children ages one to two who had a visit with a primary care provider in the last year and mean scores of 71.9% for children between age two and six and 72.3% for children ages seven through 11. In comparison, commercial plans had a mean score of 90.7% for percentage of children ages one to two who had a primary care visit in the last year; mean scores for percentage of children ages two through six and children ages seven through 11 were 80.5% and 82.%, respectively. However, the report notes that a "pattern of weak scores" for adolescent care, first identified in 1997, also was evident in the 1999 data. In 1999, 29.3% of Medicaid managed care and 28.9% of commercially insured beneficiaries ages 12 through 21 had received at least one well-care visit in the last year. This low percentage "suggests that the issue of access to health care for adolescents is a national problem," the report notes.

Other Measures
Commercial managed care plans outperformed Medicaid managed care plans in several areas during 1999. Only 59.1% of women ages 21 through 64 in Medicaid managed care plans had received a Pap smear during 1999 or the two preceding years, compared with 71.8% of women enrolled in a commercial managed care plan. In addition, 59.2% of women in Medicaid plans who gave birth during 1999 had had a prenatal care visit in their first trimester, compared with 84.5% of women in commercial plans. Further, 47.9% of women in Medicaid plans who gave birth in 1999 had a postpartum checkup within three to eight weeks after delivery, compared with 72.3% of women in commercial plans. On "benchmarks" such as childhood immunization, adolescent immunization, eye exams for diabetics and well-child visits for children ages three through six, Medicaid and commercial managed care plans scored similarly. The report also includes comparisons of benchmarks for Medicaid and commercial managed care plans compounded from 1997 through 1999 (Partridge, "The APHSA Medicaid HEDIS Database Project: Report for the Third Project Year," 12/01). The report is available online. Note: You must have Adobe Acrobat Reader to view the report.