Soban LM (VA Center for the Study of Healthcare Provider Behavior)
Yano EM (VA Center for the Study of Healthcare Provider Behavior)
Parkerton PH (UCLA, School of Public Health)
Rubenstein LV (VA Center for the Study of Healthcare Provider Behavior)
Ettner SL (UCLA, School of Medicine)
The phenomenon by which the presence of managed care influences the structure and functioning of the entire health care system—not just that within the managed care arena—is known as the “managed care spillover effect”. Possible mechanisms for this effect include influences on physician practice patterns, physician mix, and available technology. Little is known about whether the “spillover effect” also influences the processes and outcomes of care. We evaluated the extent to which levels of area managed care penetration may account for some degree of variation in the delivery of CRC screening in VA facilities.
We obtained patient data from the VHA External Peer Review Program (EPRP) and Austin datasets. Data on managed care activity—defined as the percent of HMO enrollment per total area population—were obtained from Interstudy. Facility-level covariates such as rural location, academic affiliation, and facility size were obtained from the VHA Survey of Primary Care Practices and Area Resource File. Generalized estimating equations were performed to examine the effect of local managed care activity on: (1) the probability of receiving CRC screening, and (2) the probability of receiving screening from within vs. outside the VA health care system.
The level of managed care activity surrounding VA facilities is not a significant predictor of the overall receipt of CRC screening, but is a significant, positive predictor of receipt of veterans’ CRC screening by an outside non-VA provider. Female gender and the presence of Medicare or other insurance were also significantly and positively associated with receipt of outside screening. Conversely, Black race was significantly and positively associated with receipt of within-VA screening.
Performance of VA facilities located in areas with higher levels of managed care may partially benefit from patients’ receipt of CRC screening from non-VA providers, especially for women and veterans with insurance coverage
Since VA performance measures incorporate evidence of services obtained both within and outside the VA health care system, VA facilities located in areas with lower levels of managed care penetration are at a comparative disadvantage, where patients are less likely to benefit from access to more than one system of care.