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Managed care Medicaid: How the delivery of healthcare to the most vulnerable healthcare population is changing: a general review

William Trombetta (Department of Healthcare and Pharmaceutical Marketing, Saint Joseph’s University, Philadelphia, Pennsylvania, USA)

International Journal of Pharmaceutical and Healthcare Marketing

ISSN: 1750-6123

Article publication date: 5 June 2017

Abstract

Purpose

Providing health care to the poor is evolving in the new US marketplace. The Affordable Care Act has set goals enhancing access to health care, lowering costs and improving patient outcomes. A key segment in this evolution is the most vulnerable health-care population of all: Medicaid. This paper aims to provide a general review of how providing health care to Medicaid patients is changing including how socio-economic aspects of this vulnerable population affects the quality of the health care provided.

Design/methodology/approach

The paper is entirely secondary research; no primary research has been conducted.

Findings

Managed care Medicaid provides a risk-based model to treating a vulnerable health-care market segment. The jury is still out on whether managed care Medicaid (MCM) is improving health-care quality and saving cost, but the provision of health care to the Medicaid segment is definitely shifting from a fee-for-service model to value based payment. Very recent developments of new health-care delivery approaches present a positive outlook for improving quality and containing costs going forward.

Research limitations/implications

At this stage, whether or not MCM saves money or provides better health-care quality to this vulnerable population is a work in progress. Health-care marketing can impact socio-economic aspects of health care for the poor. There is a need to follow up on the positive results being documented in demonstration health-care delivery models.

Practical implications

At this point, there has been no long-term study of whether managed care Medicaid offers better quality of health care and cost savings. The research to date suggest that the quality of health-care delivery to the poor is improving at a lower cost to payers.

Social implications

Medicaid patients are an underserved market segment. Managed care Medicaid offers a new model that has the potential to provide quality care at acceptable cost. Critical to this vulnerable market segment is the need to integrate socio-economic aspects of the population with the delivery of health care.

Originality/value

There has been very little discussion of Medicaid overall in the marketing literature, much less any discussion of managed care Medicaid.

Keywords

Citation

Trombetta, W. (2017), "Managed care Medicaid: How the delivery of healthcare to the most vulnerable healthcare population is changing: a general review", International Journal of Pharmaceutical and Healthcare Marketing, Vol. 11 No. 2, pp. 198-210. https://doi.org/10.1108/IJPHM-09-2016-0049

Publisher

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Emerald Publishing Limited

Copyright © 2017, Emerald Publishing Limited