Evaluation of a National Care Coordination Program to Reduce Utilization Among High-cost, High-need Medicaid Beneficiaries With Diabetes.
Med Care
; 58 Suppl 6 Suppl 1: S14-S21, 2020 06.
Article
em En
| MEDLINE
| ID: mdl-32412949
ABSTRACT
BACKGROUND:
Medical, behavioral, and social determinants of health are each associated with high levels of emergency department (ED) visits and hospitalizations.OBJECTIVE:
The objective of this study was 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. RESEARCHDESIGN:
Individual-level interrupted time series with a comparator group, using person-month as the unit of analysis.SUBJECTS:
A total of 42,214 UnitedHealthcare Medicaid beneficiaries (194,834 person-months) age 21 years or above with diabetes, with Temporary Assistance to Needy Families, Medicaid expansion, Supplemental Security Income 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 Supplemental Security Income beneficiaries, we observed a larger projected decrease in ED visit risk among the intervention sample versus the comparator sample at 12 months postenrollment (difference-in-difference -6.6%; 95% confidence interval -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 postenrollment (difference-in-difference -5.8%; 95% confidence interval -11.4%, -0.2%).CONCLUSION:
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.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Aceitação pelo Paciente de Cuidados de Saúde
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Medicaid
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Diabetes Mellitus
Limite:
Adult
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Aged
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Female
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Humans
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Male
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Middle aged
País como assunto:
America do norte
Idioma:
En
Ano de publicação:
2020
Tipo de documento:
Article