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TennCare--Medicaid managed care in Tennessee in jeopardy.
Am J Manag Care. 2002 Jan; 8(1):57-68.AJ

Abstract

TennCare, the statewide Medicaid managed care system implemented in Tennessee on January 1, 1994, sought to reduce state and federal healthcare expenditures while enhancing access to and quality of care. TennCare currently covers 1.32 million enrollees (25% of the citizens of Tennessee), including more than 520,248 citizens previously not covered by health insurance. It is one of the largest Medicaid managed care enterprises in the nation and the only program to cover uninsurables regardless of income. Utilization of preventive and primary care services has increased, and selected measures of quality of care have improved. Program costs from 1994 through 1998 rose at a rate below that of overall US Medicaid costs during the same period, resulting in modest savings. However, managed care plans, hospitals, and individual providers continue to report substantial fiscal losses, and managed care organizations--including the 3 largest plans in the program--have closed, been placed under receivership, or threatened to withdraw from the market. Furthermore, safety net hospitals, academic medical centers, and community mental health programs have fared financial cutbacks that have limited their ability to serve the remaining uninsured as well as the insured. Because of these fiscal difficulties, the TennCare program is now in significant jeopardy despite its important clinical successes. Major structural and fiscal changes will be required if the program is to continue to enhance services and remain financially viable. This report focuses on TennCare's successes and failures to offer lessons for Medicaid managed care programs nationwide.

Authors+Show Affiliations

Center for Health Services Research, University of Tennessee, Memphis 38163, USA. dmirvis@utmem.eduNo affiliation info availableNo affiliation info available

Pub Type(s)

Evaluation Study
Journal Article
Review

Language

eng

PubMed ID

11814173

Citation

Mirvis, David M., et al. "TennCare--Medicaid Managed Care in Tennessee in Jeopardy." The American Journal of Managed Care, vol. 8, no. 1, 2002, pp. 57-68.
Mirvis DM, Bailey JE, Chang CF. TennCare--Medicaid managed care in Tennessee in jeopardy. Am J Manag Care. 2002;8(1):57-68.
Mirvis, D. M., Bailey, J. E., & Chang, C. F. (2002). TennCare--Medicaid managed care in Tennessee in jeopardy. The American Journal of Managed Care, 8(1), 57-68.
Mirvis DM, Bailey JE, Chang CF. TennCare--Medicaid Managed Care in Tennessee in Jeopardy. Am J Manag Care. 2002;8(1):57-68. PubMed PMID: 11814173.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - TennCare--Medicaid managed care in Tennessee in jeopardy. AU - Mirvis,David M, AU - Bailey,James E, AU - Chang,Cyril F, PY - 2002/1/30/pubmed PY - 2002/3/21/medline PY - 2002/1/30/entrez SP - 57 EP - 68 JF - The American journal of managed care JO - Am J Manag Care VL - 8 IS - 1 N2 - TennCare, the statewide Medicaid managed care system implemented in Tennessee on January 1, 1994, sought to reduce state and federal healthcare expenditures while enhancing access to and quality of care. TennCare currently covers 1.32 million enrollees (25% of the citizens of Tennessee), including more than 520,248 citizens previously not covered by health insurance. It is one of the largest Medicaid managed care enterprises in the nation and the only program to cover uninsurables regardless of income. Utilization of preventive and primary care services has increased, and selected measures of quality of care have improved. Program costs from 1994 through 1998 rose at a rate below that of overall US Medicaid costs during the same period, resulting in modest savings. However, managed care plans, hospitals, and individual providers continue to report substantial fiscal losses, and managed care organizations--including the 3 largest plans in the program--have closed, been placed under receivership, or threatened to withdraw from the market. Furthermore, safety net hospitals, academic medical centers, and community mental health programs have fared financial cutbacks that have limited their ability to serve the remaining uninsured as well as the insured. Because of these fiscal difficulties, the TennCare program is now in significant jeopardy despite its important clinical successes. Major structural and fiscal changes will be required if the program is to continue to enhance services and remain financially viable. This report focuses on TennCare's successes and failures to offer lessons for Medicaid managed care programs nationwide. SN - 1088-0224 UR - https://www.unboundmedicine.com/medline/citation/11814173/TennCare__Medicaid_managed_care_in_Tennessee_in_jeopardy_ L2 - https://www.ajmc.com/pubMed.php?pii=372 DB - PRIME DP - Unbound Medicine ER -