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The Journal of Ambulatory Care... 2016As Medicaid expands in scope and influence, it is evolving toward being a "purchaser" of quality health care. This commentary discusses measurement and incentivization...
As Medicaid expands in scope and influence, it is evolving toward being a "purchaser" of quality health care. This commentary discusses measurement and incentivization of clinical outcomes in Medicaid. Advantages and disadvantages of outcome versus process measures are discussed. Distinctions are drawn between the roles of Medicare and Medicaid, including the implications of the growth in Medicaid managed care. Medicaid's influence is particularly notable for obstetric, pediatric, newborn, and long-term care. We provide data on 3 Medicaid outcomes: potentially preventable hospital admissions, readmissions, and complications. The commentary concludes with suggestions for choosing and implementing outcome-oriented value-based purchasing initiatives in Medicaid.
Topics: Hospitalization; Humans; Managed Care Programs; Medicaid; Medicare; United States; Value-Based Purchasing
PubMed: 26945295
DOI: 10.1097/JAC.0000000000000130 -
American Journal of Public Health Oct 2017
Topics: Federal Government; Health Care Reform; Humans; Medicaid; Politics; United States
PubMed: 28902546
DOI: 10.2105/AJPH.2017.304014 -
Health Services Research Feb 2020To assess the impact of a voluntary pledge policy and a mandatory nonpayment policy on reducing early-term elective deliveries among privately insured and... (Comparative Study)
Comparative Study
OBJECTIVE
To assess the impact of a voluntary pledge policy and a mandatory nonpayment policy on reducing early-term elective deliveries among privately insured and Medicaid-enrolled individuals.
DATA SOURCES/STUDY SETTING
Birth certificate data from 2009 to 2015, from South Carolina and 16 control states.
STUDY DESIGN
We use a difference-in-differences approach to test the impact of two different policy types. Outcomes include the probability of an early elective delivery, gestation time, and birthweight.
PRINCIPAL FINDINGS
The voluntary pledge and mandatory nonpayment policy reduced overall EED rates from 13.1 to 11.4 (-12.7 percent, [P < .05]), and 10.9 ([-16.6 percent, P < .05]), respectively. Compared to the privately insured, we found greater relative decreases in Medicaid EED rate, the proportion of Medicaid births occurring before 39 weeks, and the proportion of Medicaid babies born with low birthweight.
CONCLUSIONS
Both voluntary and mandatory nonpayment policies are effective in reducing the rate of EEDs, especially among Medicaid enrollees. Given the high costs and poor outcomes associated with EEDs, policy makers may consider using either tool as a way to improve care value.
Topics: Adult; Cesarean Section; Elective Surgical Procedures; Female; Health Expenditures; Humans; Insurance, Health; Medicaid; Pregnancy; United States
PubMed: 31709537
DOI: 10.1111/1475-6773.13214 -
Preventing Chronic Disease Oct 2018Food insecurity worsens health outcomes and is associated with increased health care usage and expenditures. The Supplemental Nutrition Assistance Program (SNAP) reduces...
INTRODUCTION
Food insecurity worsens health outcomes and is associated with increased health care usage and expenditures. The Supplemental Nutrition Assistance Program (SNAP) reduces but does not eliminate recipients' food insecurity. We sought to determine whether inpatient Medicaid usage and expenditure patterns responded to an April 2009 increase in SNAP benefit levels and a subsequent November 2013 decrease.
METHODS
Interrupted time series models estimated responses to the 2009 and 2013 SNAP changes in the Medicaid population, compared responses between Medicaid and Medicare recipients, and compared responses between Medicaid recipients with different likelihoods of having a disability. Analyses used 2006 through 2014 Healthcare Cost and Utilization Project National (previously Nationwide) Inpatient Sample data.
RESULTS
After the 2009 SNAP increase, Medicaid admission growth fell nationally from 0.80 to 0.35 percentage points per month (a difference of -0.45; 95% CI, -0.72 to -0.19), adjusting for enrollment. After the 2013 SNAP decrease, admission growth rose to 2.42 percentage points per month (a difference of 2.07; 95% CI, 0.68 to 3.46). Inflation-adjusted monthly Medicaid expenditures followed similar patterns and were associated with $26.5 billion (in 2006 dollars) in reduced expenditures over the 55 months of the SNAP increase, and $6.4 billion (in 2006 dollars) in additional expenditures over the first 14 months after the SNAP decrease. Effects were elevated for Medicaid compared with Medicare recipients and among people with a high likelihood of having a disability.
CONCLUSION
Although alternative causal explanations warrant consideration, changes in SNAP benefit levels were associated with changes in inpatient Medicaid usage and cost patterns.
Topics: Female; Food Assistance; Food Supply; Health Expenditures; Health Status; Health Surveys; Humans; Length of Stay; Male; Medicaid; Patient Admission; United States
PubMed: 30289106
DOI: 10.5888/pcd15.180185 -
Medical Care Jun 2020Medicaid beneficiaries with diabetes have complex care needs. The Accountable Care Communities (ACC) Program is a practice-level intervention implemented by...
BACKGROUND/OBJECTIVES
Medicaid beneficiaries with diabetes have complex care needs. The Accountable Care Communities (ACC) Program is a practice-level intervention implemented by UnitedHealthcare to improve care for Medicaid beneficiaries. We examined changes in costs and utilization for Medicaid beneficiaries with diabetes assigned to ACC versus usual care practices.
RESEARCH DESIGN
Interrupted time series with concurrent control group analysis, at the person-month level. The ACC was implemented in 14 states, and we selected comparison non-ACC practices from those states to control for state-level variation in Medicaid program. We adjusted the models for age, sex, race/ethnicity, comorbidities, seasonality, and state-by-year fixed effects. We examined the difference between ACC and non-ACC practices in changes in the time trends of expenditures and hospital and emergency room utilization, for the 4 largest categories of Medicaid eligibility [Temporary Assistance to Needy Families, Supplemental Security Income (without Medicare), Expansion, Dual-Eligible].
SUBJECTS/MEASURES
Eligibility and claims data from Medicaid adults with diabetes from 14 states between 2010 and 2016, before and after ACC implementation.
RESULTS
Analyses included 1,200,460 person-months from 66,450 Medicaid patients with diabetes. ACC implementation was not associated with significant changes in outcome time trends, relative to comparators, for all Medicaid categories.
CONCLUSIONS
Medicaid patients assigned to ACC practices had no changes in cost or utilization over 3 years of follow-up, compared with patients assigned to non-ACC practices. The ACC program may not reduce costs or utilization for Medicaid patients with diabetes.
Topics: Accountable Care Organizations; Adult; Aged; Diabetes Mellitus; Female; Health Care Costs; Humans; Male; Medicaid; Middle Aged; Patient Acceptance of Health Care; United States; Young Adult
PubMed: 32412952
DOI: 10.1097/MLR.0000000000001318 -
Medical Care Sep 2022Disparities in access to care between non-Hispanic White and Asian American, Native Hawaiian, and Pacific Islander (AANHPI) patients are often attributed to higher...
BACKGROUND
Disparities in access to care between non-Hispanic White and Asian American, Native Hawaiian, and Pacific Islander (AANHPI) patients are often attributed to higher uninsurance rates among AANHPI patients. Less is known about variation among individuals with Medicaid health insurance coverage and among AANHPI subgroups.
OBJECTIVE
The objective of this study was to examine differences in access to care between White and AANHPI adult Medicaid beneficiaries, both in the aggregate and disaggregated into 9 ethnic subgroups (Asian Indian, Chinese, Filipino, Japanese, Korean, Vietnamese, Other Asian, Native Hawaiian, and Pacific Islander).
RESEARCH DESIGN
Nationwide Adult Medicaid Consumer Assessment of Healthcare Providers and Systems data (2014-2015), a cross-sectional survey representative of all Medicaid beneficiaries.
SUBJECTS
A total of 126,728 White and 10,089 AANHPI Medicaid beneficiaries were included.
MEASURES
The study outcomes were: (1) having a usual source of care; and (2) reporting a health center or clinic as the usual site of care. Multivariable linear probability models assessed the relationship between race/ethnic subgroup and our outcomes, adjusting for sociodemographic characteristics and health status.
RESULTS
Compared with White beneficiaries, Korean beneficiaries were significantly less likely to report having a usual source of care [difference=-8.9 percentage points (PP), P =0.01], and Chinese (difference=8.4 PP, P =0.001), Native Hawaiian (difference=25.8 PP, P <0.001), and Pacific Islander (difference=22.2 PP, P =0.001) beneficiaries were significantly more likely to report a health center or clinic as their usual site of care.
CONCLUSIONS
Despite similar health insurance coverage, significant differences in access to care remain between White and AANHPI Medicaid beneficiaries. Disaggregated AANHPI data may reveal important variation in access to care and inform more targeted public policies.
Topics: Adult; Humans; Cross-Sectional Studies; Medicaid; United States; Asian American Native Hawaiian and Pacific Islander
PubMed: 35293884
DOI: 10.1097/MLR.0000000000001709 -
Public Health Reports (Washington, D.C.... 1999In summary, there are a number of ways in which state public health data can be of value in the design of Medicaid managed care plans. At the level of the purchaser,... (Review)
Review
In summary, there are a number of ways in which state public health data can be of value in the design of Medicaid managed care plans. At the level of the purchaser, such as a state Medicaid agency, public health data can assist in decision-making around pricing policy and can be useful in prioritizing interventions for those conditions that most severely affect the covered population. Quality assurance standards such as the HEDIS clinical performance measures can be used to define a baseline of prevention-oriented services or, by adding additional customized data points, to emphasize a particular service. From the standpoint of the managed care plan, public health data can be useful in understanding the needs of a community it serves or would like to serve and in estimating the prevalence of various conditions in that community that will influence the premium it will charge. Thus, there are multiple routes through which public health goals and priorities can be incorporated into managed care and can leverage the power of managed care to improve the public's health.
Topics: Data Collection; Databases, Factual; Humans; Managed Care Programs; Medicaid; Public Health; Quality Assurance, Health Care; State Health Plans; United States; Vital Statistics
PubMed: 10476991
DOI: 10.1093/phr/114.3.225 -
Health Affairs (Project Hope) Jul 2018Alternative approaches in Medicaid are proliferating under the Trump administration. Using a novel telephone survey, we assessed views on health savings accounts, work...
Alternative approaches in Medicaid are proliferating under the Trump administration. Using a novel telephone survey, we assessed views on health savings accounts, work requirements, and Medicaid expansion. Our sample consisted of 2,739 low-income nonelderly adults in three Midwestern states: Ohio, which expanded eligibility for traditional Medicaid; Indiana, which expanded Medicaid using health savings accounts called POWER accounts; and Kansas, which has not expanded Medicaid. We found that coverage rates in 2017 were significantly higher in the two expansion states than in Kansas. However, cost-related barriers were more common in Indiana than in Ohio. Among Medicaid beneficiaries eligible for Indiana's waiver program, 39 percent had not heard of POWER accounts, and only 36 percent were making required payments, which means that nearly two-thirds were potentially subject to loss of benefits or coverage. In Kansas, 77 percent of respondents supported expanding Medicaid. With regard to work requirements, 49 percent of potential Medicaid enrollees in Kansas were already employed, 34 percent were disabled, and only 11 percent were not working but would be more likely to look for a job if required by Medicaid. These findings suggest that current Medicaid innovations may lead to unintended consequences for coverage and access.
Topics: Adult; Eligibility Determination; Employment; Female; Health Services Accessibility; Humans; Indiana; Insurance Coverage; Kansas; Male; Medicaid; Middle Aged; Ohio; Patient Protection and Affordable Care Act; Poverty; United States; Young Adult
PubMed: 29924637
DOI: 10.1377/hlthaff.2018.0331 -
Health Care Financing Review 1995This overview summarizes issues addressed in this issue of the Health Care Financing Review, entitled "Medicaid and State Health Reform." Articles cover the following... (Review)
Review
This overview summarizes issues addressed in this issue of the Health Care Financing Review, entitled "Medicaid and State Health Reform." Articles cover the following topics: growth in the level of expenditures for Medicaid and creative financing strategies by States to manage these increases; section 1115 demonstration waivers; States' experiences with implementing approved section 1115 demonstrations; how section 1115 demonstration waivers fit into larger State health reform efforts; and other reform efforts in two States.
Topics: Centers for Medicare and Medicaid Services, U.S.; Eligibility Determination; Health Care Reform; Health Expenditures; Health Services Accessibility; Health Services Research; Medicaid; State Health Plans; United States
PubMed: 10142571
DOI: No ID Found -
JAMA Network Open Apr 2020State vaccination benefits coverage and access for adult Medicaid beneficiaries vary substantially. Multiple studies have documented lower vaccination uptake in publicly...
IMPORTANCE
State vaccination benefits coverage and access for adult Medicaid beneficiaries vary substantially. Multiple studies have documented lower vaccination uptake in publicly insured adults compared with privately insured adults.
OBJECTIVE
To evaluate adult Medicaid beneficiaries' access to adult immunization services through review of vaccination benefits coverage in Medicaid programs across the 50 states and the District of Columbia.
DESIGN, SETTING, AND PARTICIPANTS
A public domain document review with supplemental semistructured telephone survey was conducted between June 1, 2018, and June 14, 2019, to evaluate vaccination services benefits in fee-for-service and managed care organization arrangements for adult Medicaid beneficiaries in the 50 states and the District of Columbia (total, 51 Medicaid programs).
EXPOSURES
Document review of benefits coverage for adult immunization services and supplemental survey with validation of document review findings.
MAIN OUTCOMES AND MEASURES
Benefits coverage for adult Medicaid beneficiaries and reimbursement amounts for vaccine purchase and administration.
RESULTS
Public domain document review was completed for all 51 jurisdictions. Among these, 44 Medicaid programs (86%) validated document review findings and completed the survey. Only 22 Medicaid programs (43%) covered all 13 Advisory Committee on Immunization Practices-recommended adult immunizations under both fee-for-service and managed care organization arrangements. Most fee-for-service arrangements (37 of 49) reimbursed health care professionals using any of the 4 approved vaccine administration codes; however, 8 of 49 programs did not separately reimburse for vaccine administration to adult Medicaid beneficiaries. Depending on administration route, median reimbursement for adult vaccine administration ranged from $9.81 to $13.98 per dose. Median per-dose reimbursement for adult vaccine purchase was highest for 9-valent human papillomavirus vaccine ($204.87) and lowest for Haemophilus influenzae type b vaccine ($18.09). Median reimbursement was below the private sector price for 7 of the 13 included vaccines.
CONCLUSIONS AND RELEVANCE
Even in programs with complete vaccination benefits coverage, reimbursement amounts to health care professionals for vaccine purchase and administration may not fully cover vaccination provision costs. Reimbursement amounts below costs may reduce incentives for health care professionals to vaccinate low-income adults and thereby limit Medicaid adult beneficiary access to vaccination.
Topics: Adult; Health Services Accessibility; Humans; Immunization Programs; Medicaid; Poverty; United States; Vaccination
PubMed: 32338751
DOI: 10.1001/jamanetworkopen.2020.3316