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Evaluation of a National Care Coordination Program to Reduce Utilization among High-cost, High-need Medicaid Beneficiaries with Diabetes
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6 2020
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Source: Med Care. 58(Suppl 6 1):S14-S21
[PDF-426.51 KB]
Details:
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Alternative Title:Med Care
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Personal Author:
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Description:Background:
Medical, behavioral, and social determinants of health are each associated with high levels of emergency department (ED) visits and hospitalizations.
Objective:
To evaluate a care coordination program designed to provide combined “whole-person care,” integrating medical, behavioral and social support for high-cost, high-need Medicaid beneficiaries by targeting access barriers and social determinants.
Research Design:
Individual-level interrupted time series with a comparator group, using person-month as the unit of analysis.
Subjects:
42,214 UnitedHealthcare Medicaid beneficiaries (194,834 person-months) age ≥21 with diabetes, with Temporary Assistance to Needy Families (TANF), Medicaid expansion, Supplemental Security Income (SSI) without Medicare, or dual Medicaid/Medicare.
Measures:
Our outcome measures were any hospitalizations and any ED visits in a given month. Covariates of interest included an indicator for intervention versus comparator group and indicator and spline variables measuring changes in an outcome’s time trend after program enrollment.
Results:
Overall, 6 of the 8 examined comparisons were not statistically significant. Among SSI beneficiaries, we observed a larger projected decrease in ED visit risk among the intervention sample versus the comparator sample at 12 months post enrollment (difference-in-difference/DID: −6.6%; 95% CI: −11.2%, −2.1%). Among expansion beneficiaries, we observed a greater decrease in hospitalization risk among the intervention sample versus the comparator sample at 12 months post enrollment (DID: −5.8%; 95% CI: −11.4%, −0.2%).
Conclusions:
A care coordination program designed to reduce utilization among high-cost, high-need Medicaid beneficiaries was associated with fewer ED visits and hospitalizations for patients with diabetes in selected Medicaid programs but not others.
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Source:
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Pubmed ID:32412949
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Pubmed Central ID:PMC10653047
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Volume:58
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