Biomedical subjects

Judith Wooldridge

Publications and source records attributed to Judith Wooldridge.

3 recordsLinked to original sources

PubMed2003

SSI enrollees' health care in TennCare.

How well does TennCare, Tennessee's Medicaid managed care program, meet the needs of blind/disabled Supplemental Security Income (SSI) enrollees? People with disabilities have extensive health care needs and greater barriers to accessing care, so efforts to reduce service use may decrease their health and independence. On the other hand, managed care plans may better coordinate care. Computer-assisted telephone surveys of urban SSI and other urban TennCare enrollees were conducted to assess these issues. SSI enrollees in TennCare had mixed experiences, and they faced problems in areas particularly important to people with disabilities. Relative to other TennCare enrollees, SSI enrollees had similar or slightly worse access to care and satisfaction. A significant minority of SSI enrollees reported unmet needs for care, such as not getting referrals to specialists, prescription drugs, and special medical equipment. Lack of care coordination was a problem for some SSI enrollees.

Persons with Disabilities↗

PubMed2002

Plan characteristics and SSI enrollees' access to and quality of care in four TennCare MCOs.

OBJECTIVE: To assess hypotheses about which managed care organization (MCO) characteristics affect access to care and quality of care--including access to specialists, providers' knowledge about disability, and coordination of care--for people with disabilities. DATA SOURCES/STUDY SETTING: Survey of blind/disabled Supplemental Security Income (SSI) enrollees in four MCOs serving TennCare, Tennessee's Medicaid managed care program, in Memphis, conducted from 1998 through spring 1999. STUDY DESIGN: We compared enrollee reports of access and quality across the four MCOs using regression methods, and we use case study methods to assess whether patterns both within and across MCOs are consistent with the hypotheses. DATA COLLECTION: We conducted computer-assisted telephone surveys and used regression analysis to compare access and quality controlling for enrollee characteristics. PRINCIPAL FINDINGS: Although the four MCOs' characteristics varied, access to providers, coordination of care, and access to some services were generally similar across MCOs. Enrollees in one plan, the only MCO with a larger provider network and that paid physicians on a fee-for-service basis, reported their providers were more knowledgeable, and they had more secondary preventive care visits. Differences found in access to specialists and delays in approving care appear to be unrelated to characteristics reported by the MCOs, but instead may be related to how tightly utilization is reviewed. CONCLUSIONS: Plan networks, financial incentives, utilization management methods, and state requirements are important areas for further study, and, in the meantime, ongoing monitoring of SSI enrollees in each MCO may be important for detecting problems and successes.

Continuity of Patient Care↗

PubMed2002

Risk selection among SSI enrollees in TennCare.

The issue of risk selection is especially important for states that enroll blind and disabled beneficiaries of Supplemental Security Income (SSI) in Medicaid managed care. SSI beneficiaries have persistent needs for care, have a wide variety of chronic conditions, and often need atypical and complex services. Risk selection occurs when the health care needs of beneficiaries enrolled in a specific plan differ systematically from the needs of the overall beneficiary population and payments do not reflect those needs. We assess the extent of risk selection among managed care plans for SSI beneficiaries over the first three years of Tennessee's Medicaid managed care program, TennCare. Using claims data containing fee-for-service expenditures prior to enrollment in managed care, we find substantial evidence of persistent risk selection among plans. Results are robust to most alternative measures of risk selection for most plans.

Aid to Families with Dependent Children↗