Quality differences between fee-for-service Medicaid and managed care

This evaluation study used publicly available data from two types of state-funded Medicaid programs---fee-for-service (FFS) and managed care (MMC)---to identify whether there was a significant difference in quality of care between the two systems. For the purposes of this study, quality of care was defined by reported HEDIS scores within the measures of effectiveness of care and use of services. The organizing framework used to conduct this study was the systems theory. This framework suggests that difference in the process of producing a product or service affects the final outcome or product. The populations for this study were the Medicaid members enrolled in a managed care plan in the year 2000 and the Medicaid members enrolled in a fee-for-service plan in the year 2000. The results of this study showed that for most of the measures of quality, the scores for MMC plan were significantly higher than the scores reported by the FFS plan. Six out of the ten indicators for Effectiveness of Care showed that the MMC plan had significantly higher scores that the FFS plan. One of the indicators for Effectiveness of Care showed that the FFS plan had a significantly higher score than the MMC plan. All of the indicators for Utilization of Services showed that the MMC plan had significantly higher scores that the FFS plan.