TennCare patients require more care than the privately insured
Study results published in Tennessee Medicine: The Journal of the Tennessee Medical Association show that patients of TennCare, Tennessee’s Medicaid reform program, require more overall care than do privately insured patients.The results indicated that TennCare patients present themselves for chronic pain treatment in a more exacerbated condition than privately insured patients do, which is similar to both previous Medicaid patients and uninsured patients. TennCare patients also return for twice as many follow-up visits as privately insured patients.
The study suggests that TennCare patients may present themselves in an exacerbated conditions because they:
• underutilize their primary care physicians;
• are uneducated about changes in the health care system;
• remain in a "Medicaid" mindset;
• lack access to their MCO’s primary care physicians (due to lack of transportation or inability to miss work).
The goal of TennCare to provide health care for every person not covered by private insurance is not being met.
In the first year of TennCare operation, the average hospital was reimbursed 44 cents for every dollar spent, and the program still experienced a $99 million budget deficit. The capitation rate may need to be reassessed to determine whether the rates accurately reflect funding needs to ensure that patients continue to receive quality care.
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