New Marketplace
New Risk, New Business Models

Survey Snapshot: Medicaid Patients Receive Equal Care

Insights Report · October 13, 2016

In 2013, Ohio approved Medicaid expansion. Since then, Cleveland Clinic, like some other hospitals in the state, has experienced an increase in its Medicaid patient population, growing to 12% of the overall patient population. These patients receive the same level of care as patients insured by commercial payers, says Gregory Rosencrance, MD, FACP, Chairman of the Cleveland Clinic’s Medicine Institute.

Rosencrance is among the 35% of respondents to the most recent NEJM Catalyst New Marketplace survey of Insights Council members who say their organization always provides equal care to Medicaid patients.

Quality of Care for Medicaid Patients

New Marketplace Insights Report. Click To Enlarge.

But the larger volume is not without impact. Rosencrance says, “The shift to government payers drives the organization to find more efficiencies across the board.”

How Medicaid Helps Care

Rosencrance is among the 34% of survey respondents who say that Medicaid patients are establishing regular sources of preventative care and are better able to access and comply with prescribed therapies, though he says there is still a long way to go.

Patient Impact of Transition from Uninsured to Medicaid

New Marketplace Insights Report. Click To Enlarge.

“I think more Medicaid recipients identified a personal physician, skipped medication less often because of cost, and have more health maintenance screenings done,” he says. “These are very positive aspects of Medicaid expansion.”

As Medicaid expansion matures, he is optimistic that patients will learn how to utilize the system appropriately, including shifting away from emergency room visits and hospitalizations to primary care and outpatient visits.

But Rosencrance says the burden is shared between providers and payers to educate patients on their benefits. “Medicaid is a long-term play and will take years to change behaviors,” he says.

Lack of Clarity on Coverage

Lynda Young, MD, Ambulatory Physician Leader in Pediatrics at UMass Memorial Health Care and Clinical Professor of Pediatrics at UMass Medical School in Worcester, Massachusetts, works with a younger Medicaid population. The overall patient population at UMass Memorial Health Care includes 45% Medicaid subscribers, says Young (who is past President of the Massachusetts Medical Society, which owns NEJM Group, the publisher of NEJM Catalyst).

“For pediatrics, it’s easier if patients are on Medicaid,” she says, explaining that there is not much cost to the patient versus self-pay or some employer-negotiated contracts. Therefore, families are more likely to follow through on her treatment plans for the patient. “Some of the managed Medicaid contracts have narrow networks, so I have to be careful where I refer patients,” she says. For instance, the mental health provider embedded in her clinic can only see patients on certain Medicaid plans.

Young says that while the UMass health system always provides the same level of care to Medicaid patients as to others, patients don’t always understand the care they can get. “Our patients know they have a Medicaid card and can get care; they just don’t know the nuances,” she says. For instance, parents know they can get their child necessary vaccines but sometimes aren’t aware that they are covered for preventative primary care.

Although the NEJM Catalyst report on Medicaid concludes that the program suffers major shortcomings, Medicaid is essential in U.S. health care, says Young, pointing out that “40% of our children in America are covered by Medicaid programs!”

New Call for Submissions ­to NEJM Catalyst

Connect

A weekly email newsletter featuring the latest actionable ideas and practical innovations from NEJM Catalyst.

Learn More »

More From New Marketplace

Reframing the Conversation on Drug Pricing

We can’t afford for current trends to continue. There is only one solution.

Health Insurance Price Discounts: 2014 median hospital billed charges and median allowed (negotiated) insurance payments by admission type

The Value of Health Insurance through Price Discounts

How health insurance secures lower prices for health care services, leaving uninsured individuals facing medical debt and difficult choices.

ED Telehealth Express Care Service Patient Room

Revolutionizing the Delivery of Care for ED Patients

How the NYP OnDemand Emergency Department Telehealth Express Care Service reduced stay times and revisit rates in one year.

Targeting Unconscionable Prescription-Drug Prices — Maryland’s Anti–Price-Gouging Law

Why, in the early 21st century, are so many drugs that were cheaply available in the 20th century becoming prohibitively expensive?

The Economics of Indication-Based Drug Pricing

What would indication-based drug pricing accomplish?

Navigating Pharmaceutical Price Increases: A Strategy to Protect Appropriate Use, Reduce Waste, and Identify Therapeutic Alternatives

In the face of major pharmaceutical price increases, Cleveland Clinic developed a strategy to ensure high-quality patient care while maintaining financial stability.

Controlling the Cost of Medicaid

Both political parties should support policies that focus on incentives as a mechanism for improving and sustaining their value.

Resetting the Nation’s Health Care Quality Agenda

Poor measures of care quality have consequences. The National Quality Forum is essential to creating measures that are valid and reliable.

Opportunities for Private-Sector Entrepreneurship in Health Care Transformation

Two veterans of public service say that government can do only so much — which creates attractive business opportunities for entrepreneurs.

Moving Past the EHR Interoperability Blame Game

Why can't EHRs talk to one another? We never created the right incentives, but we pretend that we did.

Connect

A weekly email newsletter featuring the latest actionable ideas and practical innovations from NEJM Catalyst.

Learn More »

Topics

Reframing the Conversation on Drug Pricing

We can’t afford for current trends to continue. There is only one solution.

Reframing the Conversation on Drug Pricing

We can’t afford for current trends to continue. There is only one solution.

Bundled Payments

33 Articles

Progress and Path Forward on Delivery…

The basic goals of delivery system reform — to promote quality and value in our…

Insights Council

Have a voice. Join other health care leaders effecting change, shaping tomorrow.

Apply Now