| The Effects of Open Access on Member Satisfaction and Intentions to Remain in an HMO |
| | Gamble, John E. | U. of South Alabama | jgamble@usamail.usouthal.edu | (334)-460-7133 |
| | Icenogle, Marjorie L. | U. of South Alabama | micenogl@jaguar1.usouthal.edu | (334)-460-6716 |
| | Bryan, Norman B. | Georgia State U. | nbryan@gsu.edu | (770)-736-3170 |
| | Rickert, Daniel A. | PrimeHealth, Inc. | drickert@primehealth.org | (334)-380-5136 |
| | Competition in the managed care industry has intensified as the industry has reached maturity. The current competitive environment of the industry and an increasing industry-wide emphasis on cost containment have resulted in declining profits, lower levels of member satisfaction, and increasing member disenrollment. Many health maintenance organizations (HMOs), have begun to reorient their approach to competitive advantage in the industry by offering their members open access to specialists. HMO executives believe that open access will reduce the degree of differentiation achieved by fee-for-service (FFS) plans and thereby will allow HMOs to both attract additional employers and members away from FFS plans and improve overall member retention. Unfortunately, there is no empirical evidence to support this assumption. This study is the first empirical test of the strategic importance of member autonomy and open access in a managed care environment. The study expands the model of consumer satisfaction with a health care system proposed by Luft (1981) and tested by Mummalaneni and Gopalakrishna (1997). The model utilized in this study assesses the relative importance of autonomy in selecting specialists (open access), service convenience, value/pricing, and HMO resources on member satisfaction with care and intentions to remain with the HMO. Results show that all four factors significantly influence satisfaction and that subsequently, satisfaction influences intentions to retain enrollment in the plan. In addition, the importance of autonomy is demonstrated by significant direct and indirect paths to intentions to remain in the plan. |
| | Keywords: HMO member satisfaction; HMO member retention; open access |
| Strategic Factors in HMO Mergers and Acquisitions |
| | Weech-Maldonado, Robert | Pennsylvania State U., U. Park | rxw25@psu.edu | (814) 865-1926 |
| | Consolidation in the form of mergers and acquisitions has been occurring at a rapid pace in the health care industry. This has also been the trend in the health maintenance organization (HMO) sector. This study examines the strategic factors that contribute to HMO merger success in terms of post-merger financial performance. The contextual factors examined include strategic relatedness, acquirer's for-profit status, product complementarities, and acquirer and target's premerger financial performance. Strategic relatedness is conceptualized as similarity between the acquirer and target HMOs in terms of operational efficiency, HMO model, form of ownership, and organizational size.
Regression analysis showed the following factors to be associated with better postmerger financial performance: similarity in operational efficiency, dissimilarity in firm size, for-profit acquirer, adding an open-ended product, acquirer's lower premerger performance, and target's lower premerger performance. HMO structure and ownership similarities were not significantly related to postmerger performance. Knowledge and identification of strategic factors associated with favorable post-acquisition performance can be of benefit to both managers and shareholders. From a management perspective, the identification of contextual factors that can influence postmerger performance is 'strategic' in nature, and should be considered in the analysis of future HMO acquisitions.
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| | Keywords: mergers; strategy; performance |
| All care is managed: Evidence from mental health providers on the impact of utilization controls |
| | Fried, Bruce J. | U. of North Carolina, Chapel Hill | Bruce_Fried@unc.edu | (919)-966-7355 |
| | Topping, Sharon | U. of North Carolina, Chapel Hill | sharon_topping@unc.edu | (919)-966-0993 |
| | Morrissey, Joseph P. | U. of North Carolina, Chapel Hill | jmorriss@mail.schsr.unc.edu | (919)-966-7196 |
| | Stroup, Scott | U. of North Carolina, Chapel Hill | stroup@mail.schsr.unc.edu | (919)-966-0995 |
| | The treatment of the seriously mentally ill (SMI) for many years has been the responsibility of the public
sector through the Medicaid program. In recent years, managed care has moved into the Medicaid
marketplace with considerable impact. This paper examines the impact of managed behavioral healthcare
arrangements on access to services through a survey of mental health providers practicing in fee-for-service
(FFS) and managed care settings. It is hypothesized that the use of managed care utilization management
strategies has moved beyond formal managed care settings into traditional FFS settings.
The objectives of this paper are: (1) to identify differences in patterns of access to mental health services
for individuals with SMI in Medicaid FFS and Medicaid managed care settings; (2) to examine differences
in the organization and impact of utilization review mechanisms; and (3) to examine
differences in the perceived quality of decision-making processes.
Survey data were obtained from 205 mental health professionals in a Medicaid managed care setting and a
comparative FFS setting in Virginia. Professionals in the two communities reported similar levels of
access for a variety of mental health services. Access to non-medical supportive services and highly
intensive services was particularly difficult. Respondents reported similar attitudes towards utilization
management procedures including considerable distrust of external utilization management procedures.
Data confirmed the overall hypothesis of the pervasiveness of utilization management procedures
across different systems of care.
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| | Keywords: Mental health service use; Managed care; Severe mental disorders |