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Constantin J, Wehby GL. Effects of Medicaid Accountable Care Organizations on children's access to and utilization of health services. Health Serv Res 2024; 59:e14370. [PMID: 39118199 PMCID: PMC11366971 DOI: 10.1111/1475-6773.14370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2024] Open
Abstract
OBJECTIVE To evaluate the effects of Medicaid Accountable Care Organizations (ACOs) on children's access to and utilization of health services. STUDY SETTING AND DESIGN This study employs difference-in-differences models comparing ACO and non-ACO states from 2018 through 2021. Access measures are indicators for preventive and sick care sources, unmet healthcare needs, and having a personal doctor or nurse. Utilization measures are preventive and dental care, mental healthcare, specialist visits, emergency department visits, and hospital admissions. DATA SOURCES AND ANALYTIC SAMPLE Secondary, de-identified data come from the 2016-2021 National Survey of Children's Health. The sample includes children with public insurance and ranges between 21,452 and 37,177 depending on the outcome. PRINCIPAL FINDINGS Medicaid ACO implementation was associated with an increase in children's likelihood of having a personal doctor or nurse by about 4 percentage-points concentrated among states that implemented ACOs in 2018. Medicaid ACOs were also associated with an increase in specialist care use and decline in emergency visits by about 5 percentage-points (the latter being concentrated among states that implemented ACOs in 2020). There were no discernable or robust associations with other pediatric outcomes. CONCLUSIONS There is mixed evidence on the associations of Medicaid ACOs with pediatric access and utilization outcomes. Examining effects over longer periods post-ACO implementation is important.
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Affiliation(s)
- Joanne Constantin
- Department of Health Management and Policy, College of Public HealthUniversity of IowaIowa CityIowaUSA
- Department of Pediatrics, Susan B. Meister Child Health Evaluation and Research CenterUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - George L. Wehby
- Department of Health Management and Policy, College of Public HealthUniversity of IowaIowa CityIowaUSA
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Holm J, Pagán JA, Silver D. The Impact of Medicaid Accountable Care Organizations on Health Care Utilization, Quality Measures, Health Outcomes and Costs from 2012 to 2023: A Scoping Review. Med Care Res Rev 2024:10775587241241984. [PMID: 38618890 DOI: 10.1177/10775587241241984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
Most of the evidence regarding the success of ACOs is from the Medicare program. This review evaluates the impacts of ACOs within the Medicaid population. We identified 32 relevant studies published between 2012 and 2023 which analyzed the association of Medicaid ACOs and health care utilization (n = 21), quality measures (n = 18), health outcomes (n = 10), and cost reduction (n = 3). The results of our review regarding the effectiveness of Medicaid ACOs are mixed. Significant improvements included increased primary care visits, reduced admissions, and reduced inpatient stays. Cost reductions were reported in a few studies, and savings were largely dependent on length of attribution and years elapsed after ACO implementation. Adopting the ACO model for the Medicaid population brings some different challenges from those with the Medicare population, which may limit its success, particularly given differences in state Medicaid programs.
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Rappaport DI, Wilding KM, Adkins L, Bourque M, Miller JM. How Will a Shift to Value-Based Financial Models Affect Care for Hospitalized Children? Hosp Pediatr 2024; 14:e177-e180. [PMID: 38351892 DOI: 10.1542/hpeds.2023-007400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Affiliation(s)
- David I Rappaport
- Division of General Academic Pediatrics
- Utilization Management, Nemours Children's Hospital, Wilmington, Delaware
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Karen Marie Wilding
- Value-Based Services Organization, Nemours Children's Health, Wilmington, Delaware
| | - Lisa Adkins
- Utilization Management, Nemours Children's Hospital, Wilmington, Delaware
- Value-Based Services Organization, Nemours Children's Health, Wilmington, Delaware
| | - Maryanne Bourque
- Utilization Management, Nemours Children's Hospital, Wilmington, Delaware
- Value-Based Services Organization, Nemours Children's Health, Wilmington, Delaware
| | - Jonathan M Miller
- Division of General Academic Pediatrics
- Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
- Value-Based Services Organization, Nemours Children's Health, Wilmington, Delaware
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Bowness B, Henderson C, Akhter Khan SC, Akiba M, Lawrence V. Participatory research with carers: A systematic review and narrative synthesis. Health Expect 2024; 27:e13940. [PMID: 39102730 PMCID: PMC10734554 DOI: 10.1111/hex.13940] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 11/14/2023] [Accepted: 12/05/2023] [Indexed: 08/07/2024] Open
Abstract
INTRODUCTION As patient and public involvement (PPI) in research has become increasingly common, research-based recommendations on its principles and impacts have been established. The specifics of conducting PPI are likely to differ when involving different groups. Family/informal carers for those with health conditions or disabilities have a lot to contribute to research, but instances of their involvement have yet to be reviewed. OBJECTIVE To systematically review and synthesize studies where family/informal carers have been involved in the research process, to develop an understanding of the benefits, barriers and facilitating factors. METHODS A search of five electronic databases was conducted using a combination of terms relating to carers, involvement and research. A grey literature search, expert consultation and hand-searching were also used. Following screening, data extraction and quality assessment, a narrative synthesis incorporating thematic analysis was conducted. FINDINGS A total of 55 studies met the inclusion criteria, with diverse design and participatory approaches. Four themes were identified, relating to the outcomes, challenges, and practicalities of involving carers: (re) building relationships with carers; carers as equals not afterthoughts; carers have unique experiences; carers create change. Full involvement throughout the research was not always possible, due to barriers from the research world and responsibilities of the caring role. The literature demonstrated ways for carers to contribute in ways that suited them, maximizing their impact, while attending to relationships and power imbalances. CONCLUSION By summarizing the reported instances of carer involvement in research, this review brings together different examples of how successful research partnerships can be built with carers, despite various challenges. Carers are a heterogeneous group, and participatory approaches should be tailored to specific situations. Wider understanding of the challenges of conducting empowering research with carers, and the resources required to address these, are needed. PATIENT AND PUBLIC INVOLVEMENT The initial findings and themes were presented to a group of carers who had been involved in research and whose reflections informed the final synthesis.
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Affiliation(s)
- Bryher Bowness
- King's College London, Institute of PsychiatryPsychology and NeuroscienceLondonUK
| | - Claire Henderson
- King's College London, Institute of PsychiatryPsychology and NeuroscienceLondonUK
| | | | - Mia Akiba
- King's College London, Institute of PsychiatryPsychology and NeuroscienceLondonUK
| | - Vanessa Lawrence
- King's College London, Institute of PsychiatryPsychology and NeuroscienceLondonUK
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Cholera R, Anderson DM, Chung R, Genova J, Shrader P, Bleser WK, Saunders RS, Wong CA. Analysis of North Carolina Medicaid Claims Data to Simulate a Pediatric Accountable Care Organization. JAMA Netw Open 2023; 6:e2327264. [PMID: 37540515 PMCID: PMC10403786 DOI: 10.1001/jamanetworkopen.2023.27264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 06/23/2023] [Indexed: 08/05/2023] Open
Abstract
Importance Despite momentum for pediatric value-based payment models, little is known about tailoring design elements to account for the unique needs and utilization patterns of children and young adults. Objective To simulate attribution to a hypothetical pediatric accountable care organization (ACO) and describe baseline demographic characteristics, expenditures, and utilization patterns over the subsequent year. Design, Setting, and Participants This retrospective cohort study used Medicaid claims data for children and young adults aged 1 to 20 years enrolled in North Carolina Medicaid at any time during 2017. Children and young adults receiving at least 50% of their primary care at a large academic medical center (AMC) in 2017 were attributed to the ACO. Data were analyzed from April 2020 to March 2021. Main Outcomes and Measures Primary outcomes were total cost of care and care utilization during the 2018 performance year. Results Among 930 266 children and young adults (377 233 children [40.6%] aged 6-12 years; 470 612 [50.6%] female) enrolled in Medicare in North Carolina in 2017, 27 290 children and young adults were attributed to the ACO. A total of 12 306 Black non-Hispanic children and young adults (45.1%), 6308 Hispanic or Latinx children and young adults (23.1%), and 6531 White non-Hispanic children and young adults (23.9%) were included. Most attributed individuals (23 133 individuals [84.7%]) had at least 1 claim in the performance year. The median (IQR) total cost of care in 2018 was $347 ($107-$1123); 272 individuals (1.0%) accounted for nearly half of total costs. Compared with children and young adults in the lowest-cost quartile, those in the highest-cost quartile were more likely to have complex medical conditions (399 individuals [6.9%] vs 3442 individuals [59.5%]) and to live farther from the AMC (median [IQR distance, 6.0 [4.6-20.3] miles vs 13.9 [4.6-30.9] miles). Total cost of care was accrued in home (43%), outpatient specialty (19%), inpatient (14%) and primary (8%) care. More than half of attributed children and young adults received care outside of the ACO; the median (IQR) cost for leaked care was $349 ($130-$1326). The costliest leaked encounters included inpatient, ancillary, and home health care, while the most frequently leaked encounters included behavioral health, emergency, and primary care. Conclusions and Relevance This cohort study found that while most children attributed to the hypothetical Medicaid pediatric ACO lived locally with few health care encounters, a small group of children with medical complexity traveled long distances for care and used frequent and costly home-based and outpatient specialty care. Leaked care was substantial for all attributed children, with the cost of leaked care being higher than the total cost of care. These pediatric-specific clinical and utilization profiles have implications for future pediatric ACO design choices related to attribution, accounting for children with high costs, and strategies to address leaked care.
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Affiliation(s)
- Rushina Cholera
- Duke Margolis Center for Health Policy, Duke University, Durham, North Carolina
- Duke Department of Pediatrics, Duke University, Durham, North Carolina
- Duke Department of Population Health Sciences, Duke University, Durham, North Carolina
| | - David M. Anderson
- Duke Margolis Center for Health Policy, Duke University, Durham, North Carolina
- Duke Department of Population Health Sciences, Duke University, Durham, North Carolina
| | - Richard Chung
- Duke Department of Pediatrics, Duke University, Durham, North Carolina
| | - Jessica Genova
- Duke Margolis Center for Health Policy, Duke University, Durham, North Carolina
| | - Peter Shrader
- Duke Department of Population Health Sciences, Duke University, Durham, North Carolina
| | - William K. Bleser
- Duke Margolis Center for Health Policy, Duke University, Durham, North Carolina
| | - Robert S. Saunders
- Duke Margolis Center for Health Policy, Duke University, Durham, North Carolina
| | - Charlene A. Wong
- Duke Margolis Center for Health Policy, Duke University, Durham, North Carolina
- Duke Department of Pediatrics, Duke University, Durham, North Carolina
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Yang J, Shen Y, Deng Y, Liao Z. Grandchild care, inadequate medical insurance protection, and inequalities in socioeconomic factors exacerbate childhood obesity in China. Front Public Health 2022; 10:950870. [PMID: 36091537 PMCID: PMC9453265 DOI: 10.3389/fpubh.2022.950870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/22/2022] [Indexed: 01/24/2023] Open
Abstract
This study examines the influences of grandchild care and medical insurance on childhood obesity. Nationally representative longitudinal data-from the China Family Panel Studies 2010-2020-of 26,902 school-age children and adolescents aged 6-16 years and China's new reference standard ("WS/T586-2018") are used to identify a child's obesity status. Using binary mixed-effects logistic regression models and the Blinder-Oaxaca decomposition method, this study explores the roots of obesity inequalities and finds that at least 15% of Chinese children aged 6-16 were obese in the 2010s. The logistic regression analysis results indicate that grandchild care, public medical insurance, and commercial medical insurance are key risk factors of child obesity. However, the influences are heterogeneous in different groups: Grandchild care and public medical insurance increase urban-rural obesity inequalities because of a distribution effect, and grandchild care may also exacerbate children obesity inequalities between left-behind and non-left-behind children owing to the event shock of parental absence. Inequalities in socioeconomic status (SES) factors such as income, education, and region also cause obesity inequalities. These results indicate that child obesity and its inequalities are rooted in multidimensional environmental inequalities, including medical protection policies and its benefit incidence; intergenerational behavior and family SES factors; and urban-rural and left-behind risk shocks. This study provides new evidence for the development of population-based interventions and equitable medical insurance policies to prevent the deterioration of child obesity among Chinese school-age children and adolescents.
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Affiliation(s)
- Jing Yang
- School of Public Administration, Hunan University, Changsha, China
| | - Yun Shen
- School of Economics, Sichuan Agricultural University, Ya'an, China
| | - Yue Deng
- Institute of Quality Development Strategy, Wuhan University, Wuhan, China
| | - Zangyi Liao
- School of Political Science and Public Administration, China University of Political Science and Law, Beijing, China
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Schiff J, Manning L, VanLandeghem K, Langer CS, Schutze M, Comeau M. Financing Care for CYSHCN in the Next Decade: Reducing Burden, Advancing Equity, and Transforming Systems. Pediatrics 2022; 149:188221. [PMID: 35642874 DOI: 10.1542/peds.2021-056150i] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/04/2022] [Indexed: 12/15/2022] Open
Abstract
Blueprint for Change: Guiding Principles for a System of Services for CYSHCN and Their Families (Blueprint for Change), presented by the Maternal and Child Health Bureau at the Health Resources and Services Administration, outlines principles and strategies that can be implemented at the federal and state levels and by health systems, health care providers, payors, and advocacy organizations to achieve a strong system of care for children and youth with special health care needs (CYSHCN). The vision for the financing of services outlined in the Blueprint for Change: Guiding Principles for a System of Services for CYSHCN and their Families is one in which health care and other related services are accessible, affordable, comprehensive, continuous, and prioritize the wellbeing of CYSHCN and their families. There are several barriers caused or exacerbated by health care financing policies and structures that pose significant challenges for families of CYSHCN, including finding appropriate and knowledgeable provider care teams, ensuring adequate and continuous coverage for services, and ensuring benefit adequacy. Racial disparities and societal risks all exacerbate these challenges. This article outlines recommendations for improving financing for CYSHCN, including potential innovations to address barriers, such as state Medicaid expansion for CYSHCN, greater transparency in medical necessity processes and determinations, and adequate reimbursement and funding. Financing innovations must use both current and new measures to assess value and provide evidence for iterative improvements. These recommendations will require a coordinated approach among federal and state agencies, the public sector, the provider community, and the families of CYSHCN.
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Affiliation(s)
- Jeff Schiff
- Academy Health, Evidence-Informed State Health Policy Institute, Washington, District of Columbia
| | - Leticia Manning
- US Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, Rockville, Maryland
| | - Karen VanLandeghem
- National Academy for State Health Policy, Washington, District of Columbia
| | - Carolyn S Langer
- UMass Chan Medical School, Department of Family Medicine & Community Health, Worcester, Massachusetts
| | - Maik Schutze
- Kentucky Hospital Association, Louisville, Kentucky
| | - Meg Comeau
- School of Social Work, Boston University, Boston, Massachusetts
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Abstract
Pediatric-specific networks have emerged over the past decade as Medicaid payment models have shifted away from fee-for-service, which rewards volume of service delivery, towards more value-based payments that incentivize improved health outcomes. More recently, growing recognition that health care alone is insufficient to produce health has resulted in the Centers for Medicare and Medicaid Services advancing value-based payment models that allow greater flexibility for networks to address the "social determinants of health" - those social and economic conditions which significantly influence health outcomes. Although pediatricians have long advocated for understanding and addressing social health needs, pediatric networks must now determine their role in managing or mitigating the impact of these complex factors on the health of their attributed populations. Pediatric networks can implement basic screening and referral processes to address social health needs, invest network resources in direct service provision, and/or leverage the network's expertise in child health to influence upstream changes in health policy. This article presents some questions that pediatric networks can use to explore their potential role in managing social health needs.
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Affiliation(s)
- Veronica Gunn
- Genesis Health Consulting, PO Box 170724, Milwaukee, WI 53217, United States.
| | - Suzanne Brixey
- Fortify Children's Health, Children's Medical Group, Children's Hospital of the King's Daughters, Norfolk, VI, United States
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Hardy RY, Liu GC, Conkol KJ, Gleeson SP, Kelleher KJ. Left behind again: Rural home health services in a Medicaid pediatric accountable care organization. J Rural Health 2021; 38:420-426. [PMID: 33978993 PMCID: PMC9291131 DOI: 10.1111/jrh.12587] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Purpose To contrast trends in rural and urban pediatric home health care use among Medicaid enrollees. Methods Medicaid administrative claims data were used to assess differences in home health care use for child members in a large pediatric accountable care organization (ACO) in Ohio. Descriptive statistics assessed rural and urban differences in health care use over a 10‐year period between 2010 and 2019. Findings Pediatric home health care use increased markedly in the low‐income (CFC) and disabled (ABD) Medicaid categories. Over the past 10 years, CFC‐enrolled children from urban communities have seen more home health visits, fewer emergency department (ED) visits, and more well child visits compared to rural CFC‐enrolled children. Children enrolled due to disabilities in urban communities have also seen more home health visit use but fewer preventive care visits than their rural counterparts. Conclusions Within a pediatric ACO, rural home health care use has remained relatively stagnant over a 10‐year period, a stark contrast to increases in home health care use among comparable urban populations. There are likely multiple explanations for these differences, including overuse in urban communities, lack of access in rural communities, and changes to home health reimbursement. More can be done to improve rural home health access. Such improvement will likely necessitate large‐scale changes to home health care delivery, workforce, and financing. Improvements should be evaluated for return‐on‐investment not only in terms of direct costs, that is, reduced inpatient or ED costs, but also in terms of patient and family quality‐of‐life or key indicators of child well‐being such as educational attainment.
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Affiliation(s)
- Rose Y Hardy
- Abigail Wexner Research Institute at Nationwide Children's Hospital, Center for Innovation in Pediatric Practice, Columbus, Ohio, USA
| | - Gilbert C Liu
- Partners For Kids, Columbus, Ohio, USA.,Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
| | | | - Sean P Gleeson
- Partners For Kids, Columbus, Ohio, USA.,Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Kelly J Kelleher
- Abigail Wexner Research Institute at Nationwide Children's Hospital, Center for Innovation in Pediatric Practice, Columbus, Ohio, USA.,Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
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Bui LN, Yoon J, Harvey SM, Luck J. Coordinated Care Organizations and mortality among low-income infants in Oregon. Health Serv Res 2019; 54:1193-1202. [PMID: 31657003 DOI: 10.1111/1475-6773.13228] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVE To examine the impact of Oregon's Coordinated Care Organizations (CCOs), an accountable care model for Oregon Medicaid enrollees implemented in 2012, on neonatal and infant mortality. DATA SOURCES Oregon birth certificates linked with death certificates, and Medicaid/CCO enrollment files for years 2008-2016. STUDY DESIGN The sample consisted of the pre-CCO birth cohort of 135 753 infants (August 2008-July 2011) and the post-CCO birth cohort of 148 650 infants (August 2012-December 2015). We used a difference-in-differences probit model to estimate the difference in mortality between infants enrolled in Medicaid and infants who were not enrolled. We examined heterogeneous effects of CCOs for preterm and full-term infants and the impact of CCOs over the implementation timeline. All models were adjusted for maternal and infant characteristics and secular time trends. PRINCIPAL FINDINGS The CCO model was associated with a 56 percent reduction in infant mortality compared to the pre-CCO level (-0.20 percentage points [95% CI: -0.35; -0.05]), and also with a greater reduction in infant mortality among preterm infants compared to full-term infants. The impact on mortality grew in magnitude over the postimplementation timeline. CONCLUSIONS The CCO model contributed to a reduction in mortality within the first year of birth among infants enrolled in Medicaid.
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Affiliation(s)
- Linh N Bui
- College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon.,Health Management and Policy Program, College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon
| | - Jangho Yoon
- College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon.,Health Management and Policy Program, College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon
| | - S Marie Harvey
- College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon.,Health Management and Policy Program, College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon
| | - Jeff Luck
- College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon.,Health Management and Policy Program, College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon
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Song PH, Xu WY, Chisolm DJ, Alexy ER, Ferrari RM, Hilligoss B, Domino ME. How does being part of a pediatric accountable care organization impact health service use for children with disabilities? Health Serv Res 2019; 54:1007-1015. [PMID: 31388994 DOI: 10.1111/1475-6773.13199] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To examine the impact of a Medicaid-serving pediatric accountable care organization (ACO) on health service use by children who qualify for Medicaid by virtue of a disability under the "aged, blind, and disabled" (ABD) eligibility criteria. DATA SOURCES/STUDY SETTING We evaluated a 2013 Ohio policy change that effectively moved ABD Medicaid children into an ACO model of care using Ohio Medicaid administrative claims data for years 2011-2016. STUDY DESIGN We used a difference-in-difference design to examine changes in patterns of health care service use by ABD-enrolled children before and after enrolling in an ACO compared with ABD-enrolled children enrolled in non-ACO managed care plans. DATA COLLECTION/EXTRACTION METHODS We identified 17 356 children who resided in 34 of 88 counties as the ACO "intervention" group and 47 026 ABD-enrolled children who resided outside of the ACO region as non-ACO controls. PRINCIPAL FINDINGS Being part of the ACO increased adolescent preventative service and decreased use of ADHD medications as compared to similar children in non-ACO capitated managed care plans. Relative home health service use decreased for children in the ACO. CONCLUSIONS Our overall results indicate that being part of an ACO may improve quality in certain areas, such as adolescent well-child visits, though there may be room for improvement in other areas considered important by patients and their families such as home health service.
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Affiliation(s)
- Paula H Song
- Department of Health Policy and Management, The Gillings School of Global Public Health, and The Cecil G. Sheps Center for Health service Research, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Wendy Yi Xu
- Division of Health Service Management and Policy, College of Public Health, Division of General Internal Medicine, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio
| | - Deena J Chisolm
- Department of Pediatrics, Center for Innovation in Pediatric Practice, The Research Institute at Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio
| | | | - Renée M Ferrari
- Carolina Cancer Screening Initiative, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Carrboro, North Carolina
| | - Brian Hilligoss
- Management & Organizations, Eller College of Management, The University of Arizona, Tucson, Arizona
| | - Marisa Elena Domino
- Department of Health Policy and Management, The Gillings School of Global Public Health, and The Cecil G. Sheps Center for Health service Research, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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