Social workers often take on the role of providing case management to Medicaid recipients; however, there is little clinical research on social workers' perceptions of their case management role. The purpose of this study was to develop an understanding of the social worker case management role by exploring social workers' perceptions of their roles when providing case management to Ohio Medicaid managed care enrollees. This action research study was grounded in organizational role theory. A semi structured focus group was facilitated using open-ended questions related to social workers' role perceptions, role conflict, role ambiguity, case management, and managed care. Qualitative data were collected from 5 licensed Ohio social workers working as case managers with clients enrolled in an Ohio Medicaid managed care plan. The data were coded and analyzed using constant comparison analysis to identify relevant themes. Four themes emerged from the data: care coordination, role conflict and ambiguity, lack of social work influence in managed care, and resources. The findings of the study may serve as a step toward filling gaps in the understanding of the role of social workers who provide case management services to Ohio's Medicaid managed care enrollees. The findings may also be used to effect positive social change by increasing stakeholders' understanding of social workers' roles in case management and encouraging stakeholders to take steps to identify and address possible role conflict and ambiguity.

The purpose of this research was to understand cost containment strategies used by private hospitals under managed care plans and their relationship to quality of care within the South African environment. The data was collected using a questionnaire consisting of closed questions requesting respondents to rate statements about costs and quality of care, as well as open questions for additional information about costs and quality of care. The study found that managed care has the ability to control costs and that hospitals monitor LOS and prescribe generic medication in order to control costs. The study also found that cost control strategies have a negative impact on quality of care and that hospitals place more emphasis on cost control than quality of care. In addition, large hospitals that enjoy high occupancy rates experienced an increase in patient complaints since the introduction of managed care, compared to small and medium hospitals. The study found that managed care has had a better than average impact on controlling costs and a better than average impact in quality reduction, however the correlation between cost control and quality reduction was negative. Finally, the study found that technology has an impact on rising healthcare costs and that any constraints placed on rising costs associated with technology will have a negative impact on quality of care. Copyright / Dissertation (MBA)--University of Pretoria, 2010. / Gordon Institute of Business Science (GIBS) / unrestricted

Pregnant people with substance use disorders (SUD) are at high risk of potentially avoidable morbidity and mortality. In particular, pregnant people with opioid use disorder (OUD) have experienced large increases in maternal mortality, largely driven by rising rates of drug overdose. The majority of pregnant people with SUD receive health insurance through state Medicaid programs, many of which use private Medicaid managed care (MMC) plans to finance and deliver health care services rather than through the state-run fee-for-service (FFS) plan. MMC plans receive capitated payments in exchange for coverage of a defined set of benefits. Pregnant people with SUD are predictably high-cost and high-need, and MMC plans may not be able to recoup the high cost of services used over often short periods of enrollment associated with pregnancy. While capitation may incentivize MMC plans to promote access to high-value services that reduce the risk of poor maternal health outcomes, it might also incentivize plans to restrict access to certain services or alter their provider networks in ways that reduce costs. Despite being the dominant delivery vehicle of insurance coverage to this growing population, no research has examined the association between MMC enrollment and maternal health outcomes among pregnant people with any SUD or with OUD. In this Dissertation, I use the newly-available Transformed Medicaid Statistical Information System Analytic Files (TAF) across all three studies. The newly-available TAF files contain claims data for all Medicaid enrollees from all 50 states and the District of Columbia, and represent the most comprehensive data source for longitudinal inpatient and outpatient health service utilization among Medicaid enrollees. In the first study, I develop and validate an algorithm to identify live births using the TAF data. I find that using claims in both the inpatient and other services files are critical to accurately capture live births at the state-year and state-month level. In the second study, I first estimate the burden of SUD and OUD among pregnant people enrolled in Medicaid, and the prevalence of adverse maternal health outcomes in these groups. Next, I examine the association of severe maternal morbidity (SMM) and MMC enrollment among pregnant people with SUD and, separately, OUD nationally from 2016-2018. I find that SMM within six weeks of delivery is more prevalent among those with any SUD (3.2%) and OUD (3.9%) than those without either diagnosis (1.6%). Moreover, I find that enrollment in MMC (vs. Medicaid FFS) is associated with a 0.54 percentage-point (pp) and a 0.66 pp reduction in the probability of SMM among those with any SUD and among those with OUD, respectively. In the third study, I estimate the effect of MMC enrollment on adverse maternal health outcomes using data from two states (Illinois and Missouri) that expanded MMC to statewide. Using difference-in-differences models, I find that expansion of MMC did not change the probability of adverse maternal health outcomes among pregnant people with any SUD. These results suggest that at a minimum MMC has not worsened health outcomes among those with SUD, and at best, MMC may be driving incremental improvements for this group at high-risk of morbidity and mortality. / 2025-07-25T00:00:00Z

Universiẗat, Diss--Köln, 2007.

Thesis (Ph. D.)--Rand Graduate School, 2002. / Includes bibliographical references (p. 64-70).

Thesis (Ph. D.)--RAND Graduate School, 2000. / Includes bibliographical references (p. 309-317).

Thesis (Ph. D.)--RAND Graduate School, 2000. / Includes bibliographical references (p. 309-317).

Thesis (M.S.)--University of Michigan, 1995.

Thesis (Ph. D.)--Rand Graduate School, 2002. / Includes bibliographical references (p. 64-70). Also available online.

Thesis (M.S.)--University of Michigan, 1995.