Date of Award
2005
Degree Type
Dissertation
First Advisor
Paul Larrat
Abstract
Recipient restriction, defined as the locking-in of Medicaid recipients who tend to doctor or pharmacy "shop" into one specific provider and/or pharmacy, has been utilized by State Medicaid agencies and Medicaid managed care organizations as a measure to not only control misutilization and overutilization of Medicaid services through the reduction of unnecessary or inappropriate services, but also to better manage and improve members' quality of care. The objectives of this research was three-fold: to document the prevalence of recipient restriction programs in State Medicaid agencies and Medicaid managed care organizations (MCO); examine the impact these programs have as a measure to control misutilization and overutilization of Medicaid services; and provide an analysis of recipient restriction in a Northeastern Medicaid Managed Care Organization (NMMCO) through the analysis of both medical and pharmacy claims data and document the effect the program has as a cost-savings measure to the organization. The ultimate goal of this research was to examine recipient restriction at the national level, focusing on Medicaid managed care with a detailed analysis of a single Medicaid MCO.
Recommended Citation
Beaubien, Jason Michael, "Effectiveness of recipient restriction programs in Medicaid managed care organizations" (2005). Open Access Dissertations. Paper 2070.
https://digitalcommons.uri.edu/oa_diss/2070
Terms of Use
All rights reserved under copyright.