Describe the impact of managed care on both the Medicare and Medicaid programs.

Question

What will be an ideal response?

Answer 1

• The implications for patients served under Medicare are potentially good and bad. On the positive side, Medicare beneficiaries may receive more benefits and services and may also have their patterns of care and the outcomes of that care more closely monitored and controlled. Medicare beneficiaries may actually get more appropriate care in managed care plans and may have more confidence in that care. Conversely, the effects associated with consolidation among provider organizations and medical groups may have a negative impact on Medicare beneficiaries. Moving into a Medicare managed care program may indicate that elderly patients spend less time with their physicians and, therefore, have a less personal connection to them.
• In the case of Medicaid, changes associated with the increased use of managed care are more likely to be positive than negative. Under managed care, Medicaid recipients have a firm and formal connection with a medical group or medical provider and will be required to have a designated PCP as the coordinator of all health care services. This will allow Medicaid recipients to have continuous access to care from a single provider network. Thus, managed care presents a great opportunity to improve the quality of care received by Medicaid recipients across the country.