Evaluation of a National Care Coordination Program to Reduce Utilization among High-cost, High-need Medicaid Beneficiaries with Diabetes

Details

• Alternative Title:
  Med Care
• Personal Author:
  Duru, O. Kenrik ; Harwood, Jessica ; Moin, Tannaz ; Jackson, Nick ; Ettner, Susan ; Vasilyev, Arseniy ; Mosley, David G. ; O’Shea, Donna L. ; Ho, Sam ; Mangione, Carol M.
• 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.
  
  
• Keywords:
  Adult Aged Diabetes Mellitus Emergency Department Emergency Service, Hospital Female Health Care Costs Health Services Needs And Demand Hospitalization Humans Male Medicaid Middle Aged Patient Acceptance Of Health Care Program Evaluation United States Utilization Young Adult

  More +
• Source:
  Med Care. 58(Suppl 6 1):S14-S21
• Pubmed ID:
  32412949
• Pubmed Central ID:
  PMC10653047
• Document Type:
  Journal Article
• Funding:
  U18 DP006128/DP/NCCDPHP CDC HHSUnited States/
• Volume:
  58
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha256:8a84c38df114926505a338927b52edf16a255f5c41c615758cbbc419ea87ac71
• Download URL:
  https://stacks.cdc.gov/view/cdc/135514/cdc_135514_DS1.pdf
• File Type:
  [PDF - 426.51 KB ]