Can Medicaid Managed Care mitigate race/ethnic health disparities in diabetes?

Professor Maria Alva and her MDI team were recently awarded a grant by National Institute On Minority Health And Health Disparities, a division of the NIH, for over $525,000.

“I am very excited to get to work with a multi-disciplinary team of colleagues at Georgetown, Emory, and the University of Central Florida with economics, public health, medical and qualitative expertise to create a multi-state mixed-methods study.”

Maria Alva, PhD

There are large differences across states and within states across races in both ER use and avoidable hospitalizations among individuals diagnosed with diabetes. Medicaid covers 20% of Americans, of which two-thirds are minorities. Medicaid also covers 25% of all adults with diabetes. States contract with Medicaid Managed Care (MMCO) to lower costs, increase quality and pass on the financial risks of covering Medicaid beneficiaries.

This study aims to collect high-quality, multi-state data to assess whether different permutations of MMCOs/ state features have contributed to the widening of type-2 diabetes disparities and to understand how these programs influence diabetes outcomes.

Diabetes is the perfect test case to understand the quality of the care process because there are concrete, evidence-based clinical guidelines (HEDIS, NCQA, ADA) that can act as benchmarks. Some of these metrics are identifiable through claims data by looking at testing, examinations, and prescriptions.

With the increase in privatization of Medicaid, it is important to begin to understand whether or not companies are incentivized to keep costs down or to invest in preventive care. It is also important to understand how high-risk and high cost patients may be impacted by certain practices. The work done on this grant will begin to address these types of questions with respect to diabetes.

“Increasingly, most of Medicaid is administered by private companies with taxpayer dollars. Whether companies are for-profit or not, they are reimbursed a fixed amount per member and are therefore incentivized to control costs. Does this kind of arrangement incentivize companies to invest in preventive care?”

Maria Alva, PhD