Department of Social Sciences and Health Policy, Division of Public Health Sciences, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157-1063, USA.
Section of General Internal Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
J Gen Intern Med. 2023 Nov;38(15):3295-3302. doi: 10.1007/s11606-023-08319-9. Epub 2023 Jul 24.
On July 1, 2021, North Carolina's Medicaid Transformation mandatorily switched 1.6 million Medicaid beneficiaries from fee-for-service to managed care plans. We examined the early enrollee experience in terms of engagement in plan selection, provider continuity, use of primary care visits, and assistance with social needs.
Using electronic health records (EHR) covering pre- and post-transition periods (1/1/2019-5/31/2022) from the largest provider network in western North Carolina, we identified all children and adults under age 65 with continuous Medicaid or private coverage. We conducted primary surveys of a random sample of Medicaid-covered enrollees and obtained self-reported rates of engagement in plan selection, continuity of provider access, and receipt of social need assistance. We used comparative interrupted time series models to estimate the relative change in primary care visits associated with the transition.
Our EHR-based study cohorts included 4859 Medicaid and 5137 privately insured enrollees, with 398 Medicaid enrollees in the primary surveys. We found that 77.3% of survey participants reported that the managed care plan they were on was not chosen but automatically assigned to them, 13.1% reported insufficient information about the transition, and 19.2% reported lacking assistance with plan choice. We found that 5.9% were assigned to a different primary care provider. Over 29% reported not receiving any additional social need assistance. The transition was associated with a 7.1% reduction (95% CI, -11.5 to -2.7%) in the volume of primary care visits among Medicaid enrollees relative to privately insured enrollees.
Medicaid enrollees in North Carolina may have had limited awareness and engagement in the transition process and experienced a reduction in primary care visits. As the state's transition process gains a foothold, future policy needs to improve enrollee engagement and develop evidence on healthcare utilization and patient outcomes.
2021 年 7 月 1 日，北卡罗来纳州的医疗补助计划（Medicaid）强制性地将 160 万医疗补助受助人从按服务收费转变为管理式医疗计划。我们根据参与计划选择、提供者连续性、初级保健就诊使用情况和社会需求援助情况，研究了早期参保人的体验。
我们使用北卡罗来纳州西部最大的医疗服务提供商网络的电子健康记录（EHR），覆盖了从 2019 年 1 月 1 日至 2022 年 5 月 31 日的过渡期前后，确定了所有年龄在 65 岁以下、有连续医疗补助或私人保险的儿童和成年人。我们对随机抽取的医疗补助参保人进行了初步调查，了解他们参与计划选择、获得提供者连续性服务和接受社会需求援助的情况。我们使用比较中断时间序列模型来估计与过渡相关的初级保健就诊的相对变化。
我们基于 EHR 的研究队列包括 4859 名医疗补助和 5137 名私人保险参保人，其中有 398 名医疗补助参保人接受了初步调查。我们发现，77.3%的调查参与者表示，他们所在的管理式医疗计划不是自己选择的，而是自动分配给他们的；13.1%的人表示，他们对过渡情况了解不足；19.2%的人表示，他们在选择计划时没有得到帮助。我们发现有 5.9%的人被分配到了不同的初级保健提供者。超过 29%的人表示没有得到任何额外的社会需求援助。与私人保险参保人相比，医疗补助参保人的初级保健就诊量减少了 7.1%（95%CI：-11.5 至-2.7%）。
北卡罗来纳州的医疗补助参保人可能对过渡过程的意识和参与度有限，并经历了初级保健就诊量的减少。随着该州的过渡过程逐渐稳定，未来的政策需要提高参保人的参与度，并在医疗保健利用和患者结果方面积累证据。
