Melissa Bright, Ph.D., assistant research scientist in the Department of Health Outcomes and Policy, was recently named a 2015 New Investigator as part of AcademyHealth’s New Investigator Small Grant Program (NISGP). She was awarded a $10,000 grant for her proposal to examine the effects of a change in Medicaid service delivery on the quality and costs of health care for foster youth.
“Unfortunately, less than half of all states met performance standards for providing foster youth adequate services to meet their physical health needs in 2011,” said Bright, who has a growing research portfolio surrounding pediatric care and adverse childhood events. “These children are often relocated, making it difficult for them to maintain a medical home and causing delays in care, poor continuity of care, poor medication management, and a host of other unmet health care needs.”
Bright’s proposal focuses on the state of Texas’ change from a fee-for-service (FFS) Medicaid plan for foster youth to a managed care specialty plan. A FFS structure reimburses providers at a lower rate than most other insurance plans, which often leads to difficulty in establishing a primary care provider and is more costly to federal and state governments. Managed care is a more integrated system, which offers the potential of better care due to a larger network of providers and an emphasis on preventive care. Moreover, a specialty plan for foster youth considers the particular needs of this vulnerable population.
While some studies have examined how a shift to managed care has improved the use of mental health services by foster youth, Bright plans to examine the impact of the shift on physical health quality by comparing Medicaid claims and encounter data in Texas, which switched to manage care in 2005, and Florida, which primarily enrolled foster youth in FFS between 2005 and 2011. The Institute for Child Health Policy serves as the external quality review organization (EQRO) for the Texas Medicaid programs and holds several contracts to evaluate Florida’s Medicaid programs, which gives Institute faculty the unique opportunity to work with the states and their data to conduct research. Specifically, Bright will look at foster youth’s access to primary and dental care, their health care utilization, the effectiveness of their care, and health care expenditures.
“Ultimately, I hope this study will provide a framework for examining how other states transition from FFS to managed care,” said Bright. “There is also more work to be done in examining whether improvements have been made in maintaining continuity of care for these children and in gathering on-the-ground perspectives regarding this shift. I see this endeavor as the first of many projects aimed at improving this vulnerable population’s experience with the health care system.”