The Impact of Tobacco Smoke Exposure on Childhood Asthma in a Medicaid Managed Care Plan.

BACKGROUND: Tobacco smoke exposure increases breathing problems of children. Texas Children's Health Plan is a Managed Medicaid and Children's Health Insurance Program (CHIP) managed care provider. The aim of this study is to determine associations among tobacco smoke exposure, asthma prevalence, and asthma health-care utilization. METHODS: Texas Children's Health Plan conducts an annual survey of members who have a physician visit. Questions were added to the survey in March 2010 about asthma and tobacco smoke exposure. Survey results for children < 18 years of age were matched to health plan claims data for the 12 months following the date of the physician visit. RESULTS: A total of 22,470 parents of unique members/patients from birth to < 18 years of age participated in the survey. More whites than African Americans or Hispanics report that the child's mother is a smoker (19.5% vs 9.1% and vs 2.3%, respectively; P < .001). Compared with children whose mother does not smoke, parent report of asthma diagnosis and claims for dispensing of short-acting beta agonist medication are greater if the mother is a smoker (adjusted OR, 1.20 [95% CI, 1.03-1.40] and 1.24 [95% CI, 1.08-1.42], respectively). In contrast to Medicaid, in which there are no out-of-pocket costs, the CHIP line of business requires copays for ED visits. ED visits are influenced by maternal smoking only in the CHIP line of business (adjusted OR, 4.40; 95% CI, 1.69-11.44). CONCLUSION: Maternal smoking increases risk for asthma diagnosis and prescription of asthma quick relief medication. Maternal smoking predicted asthma-related ED visits only for the CHIP line of business.

Quality improvement for medicaid members of a commercial health plan: impact on racial/ethnic differences.

OBJECTIVE: To describe one commercial Medicaid Managed Care (MMC) health plan's quality improvement (QI) program that achieved high varicella immunization rates among members of an ethnically diverse population in California. DESIGN: Retrospective study using administrative data. PATIENTS: Blue Cross of California Medicaid enrolled children who turned two years old during each calendar year of the study. INTERVENTION: A specialized immunization strategy was implemented with data collected at three time points, pre-intervention (baseline--1998/1999), two-year followup (2001) and three-year followup (2002). MAIN OUTCOME MEASURE: Varicella vaccination coverage after the QI initiative. RESULTS: A statistically significant increase in varicella immunization rates for the study population was observed between baseline (49.5%) and three-year follow up (89.4%). Baseline differences in immunization rates by physician type and patient ethnicity were reduced. CONCLUSION: Trends in varicella vaccination coverage among members of this commercial MMC plan are in line with trends in overall vaccination coverage in California, indicating that commercial MMC health plans have the capacity to offer accessible and high quality care to ethnically diverse patients to mediate racial/ethnic differences. More work is needed to explore the impact of quality improvement programs of MMC plans in other areas.