Managed competition and spill-over effects

I want to know if an awesome paper has been written and I just have not seen it.

What is the integrated spill-over effects of all managed competition health systems on the general practice and cost of medicine?

We have a rich literature that shows more Medicare Advantage marketshare leads to lower risk adjusted spending for traditional Medicare.

There is a decent literature that Medicaid managed care saves money compared to fee for service Medicaid.

The Affordable Care Act has encouraged the formation of Accountable Care Organizations. The early data suggests small but real savings for ACO participants compared to fee for service Medicare.

And then we have the private sphere with employer and individual plans offering a wide variety of managed products ranging from the traditional gatekeeper HMO model to centers of excellence and reference pricing.

All of these systems are designed to either nudge or hip check providers and patients to select more efficient care. The Medicare Advantage literature suggests that once a threshold of patients under an MA contract is achieved, regions will redesign the care flow to accomodate the demands of Medicare Advantage payers. And once the care flow is redesigned, providers are not checking to see if Mrs. Jones is a Medicare Advantage or just a traditional Medicare patient when they build their discharge plan or the congestive heart failure monitoring plan. This is where the spill-over occurs that leads to lower costs for traditional Medicare in high Medicare Advantage regions.

So my question is if we were to quantify how much of a region’s total healthcare spending was routed through some type of managed competition vehicle, would there be regional spillover effects?

I want to read that paper. I know I don’t have the data nor the technical chops to write that paper, but I so want to read it.

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