Do provider service networks result in lower expenditures compared with HMOs or primary care case management in Florida's Medicaid program?

Health Serv Res. 2014 Jun;49(3):858-77. doi: 10.1111/1475-6773.12129. Epub 2013 Nov 18.


Objective: To determine the impact of Florida's Medicaid Demonstration 4 years post-implementation on per member per month (PMPM) Medicaid expenditures and whether receiving care through HMOs versus provider service networks (PSNs) in the Demonstration was associated with PMPM expenditures.

Data: Florida Medicaid claims from two fiscal years prior to implementation of the Demonstration (FY0405, FY0506) and the first four fiscal years after implementation (FY0607-FY0910) from two urban Demonstration counties and two urban non-Demonstration counties.

Study design: A difference-in-difference approach was used to compare changes in enrollee expenditures before and after implementation of the Demonstration overall and specifically for HMOs and PSNs.

Data extraction: Claims data were extracted for enrollees in the Demonstration and non-Demonstration counties and collapsed into monthly amounts (N = 26,819,987 person-months).

Principal findings: Among SSI enrollees, the Demonstration resulted in lower increases in PMPM expenditures over time ($40) compared with the non-Demonstration counties ($186), with Demonstration PSNs lowering PMPM expenditures by $7 more than HMOs. Savings were also seen among TANF enrollees but to a lesser extent.

Conclusions: The Medicaid Demonstration in Florida appears to result in lower PMPM expenditures. Demonstration PSNs generated slightly greater reductions in expenditures compared to Demonstration HMOs. PSNs appear to be a promising model for delivering care to Medicaid enrollees.

Keywords: Administrative data uses; Medicaid; health care costs; health care organizations and systems.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Case Management / economics*
  • Child
  • Child, Preschool
  • Female
  • Florida
  • Health Expenditures*
  • Health Maintenance Organizations / economics*
  • Humans
  • Infant
  • Male
  • Medicaid*
  • Middle Aged
  • Primary Health Care / economics*
  • United States
  • Young Adult