Using a Model to Evaluate the Impact of Managed Care on Medicaid-Eligible Moms and Their Children in a Rural Population

This paper lays out the advantages of using a model for developing research questions and methodologies aimed at evaluating how managed care arrangements for rural Medicaid moms and their children might affect their access to health care and their related health status. The PRECEDE (predisposing, reinforcing, and enabling causes in educational diagnosis and evaluation) health-education program planning model is refined and applied to a population of Medicaid-eligible moms and their children to help organize and clarify the research questions and to identify the types of variables we need to consider for this exercise. An explanation of those variables, why they are important, and how they can be obtained is presented. Using a Model to Evaluate the Impact of Managed Care on Medicaid-Eligible Moms and Their Children in a Rural Population This paper lays out the advantages of using a model for developing research questions and methodologies aimed at evaluating how managed care arrangements for rural Medicaid moms and their children might affect their access to health care and their related health status. Previously (Riportella-Muller and Selby 1990; Selby et al. 1989), the author adapted and used the PRECEDE health-education program planning model (Green et al. 1980) to design interventions to improve utilization in the preventive health care program for Medicaid-eligible children and then to plan for their evaluation. Here, we refine the model further to help organize and clarify the research questions and to identify the types of variables we need to consider for studying the impact of managed care on rural Medicaid moms and their children in Wisconsin. While the PRECEDE (predisposing, reinforcing, and enabling causes in educational diagnosis and evaluation) model is usually applied as an intervention and evaluation planning tool, we have not used the model for the intervention, which was planned by the state and is currently being implemented in most of Wisconsin’s counties. The model still proves valuable for developing a full evaluation design, however. We hope that our experience with applying this refined model will help others who are trying to understand and evaluate the implications of this change to managed care for rural Medicaid populations. The model may help to ensure that the appropriate questions are asked when planning the transition to managed care to rural Medicaid moms and their children. It should also serve as a guide to planning theory-based research in general.