Addressing Fragmentation in the Health Care of Medicare and Medicaid Beneficiaries

Using New York State Medicare and Medicaid claims data for the period 2008 to 2013, the investigators will measure health care fragmentation for Medicare fee-for-service beneficiaries, Medicaid fee-for-service and managed care beneficiaries, and dual-eligible enrollees. The goal is to determine how fragmentation in ambulatory care changes over time and how it varies by insurance product (fee-for-service vs. managed care). First, the project team will examine this variation at the population level, looking at trends in fragmentation over a timeframe that includes the expansion of Medicaid managed care. Second, the team will compare the experiences of beneficiaries who switched from fee-for-service to managed care to those of beneficiaries who remained consistently in one or the other.

Project findings could inform the design of policies to incentivize less fragmentation in care. This work is particularly timely and relevant given that both the federal government and states seek to enroll more beneficiaries in managed care, with the intention that it will to lead better outcomes and more efficient use of services for Medicare and Medicaid enrollees.