Medicaid Managed Care Evaluation Outcome Report - Outcomes of Care for Iowa Medicaid Members, State Fiscal Years 2014 and 2016
The University of Iowa Public Policy Center (PPC) provides outcome measures for the Iowa Medicaid Managed Care Program, annually reporting rates to the Iowa Department of Human Services (IDHS). Eight measures have been reported consistently over the past 13 years as recommended by CMS. The measures reported within this report encompass those outcomes that are derived from administrative data including claims, encounters and enrollment. Beginning April 1, 2016 most Medicaid members were provided health care through Managed Care Organizations (MCOs).
In previous reports, we used the State Fiscal Year (FY) running from July 1 of the first year through June 30 of the second year. This ‘measurement’ year made the most sense, as state programs are normally started and renewed based on the FY. However, beginning with this report, we will utilize the calendar year (CY) as the ‘measurement’ year for our reports. Reporting for the calendar year allows us to absorb, most of the first year of the MCOs in CY 2016. Were we to report on the fiscal year (FY), we would have Medicaid members in MediPASS or Meridian HMO for 6 months, then Fee-for-service for 3 months and then in one of the MCOs for 3 months. Using calendar year (CY) we have members in MediPASS or Meridian HMO for CY 2015 (baseline year) and then in 3 months of Fee-for-Service and 9 months in one of the MCOs during CY 2016.
We use CY 2015 as our baseline comparison year, however, the managed care options were different – limited to MediPASS (PCCM) and Meridian HMO. In addition, in previous years we have provided the rates for individuals in the non-managed Fee-for-Service component of Medicaid and those eligible due to disability determination. For this report, we continue to use these categorizations for CY 2015 with a shift to grouping by MCO for CY 2016. For many measures we are unable to report the rates by MCO for the DD group due to low numbers which lead to unstable rates. In addition, we provide no statistical measure of significance for our results, as we are reporting on the populations within each group. The significance of differences lies not so much in a statistical measure, but in the interpretation of stakeholders. For the most part, there is usually less than a 5% difference between the MCOs.