Aydede SK, Dick A, Vogel B, Sappington D, Shenkman EA; AcademyHealth. Meeting (2005 : Boston, Mass.).
Abstr AcademyHealth Meet. 2005; 22: abstract no. 4371.
University of Florida, Institute for Child Health Policy, PO Box 100147, Gainesville, FL 32610 Tel. (352)265-7220 x86335 Fax (352)265-7221
RESEARCH OBJECTIVE: Commercial health plan exits have increased the rate of plan turnover in Medicaid markets. When plans exit the market, their enrollees must transfer to remaining health plans. We employed data from a large states Medicaid Managed Care program to examine the health status of children involuntarily transferring from health plans exiting the Medicaid market and the short term impact of these transfers on the children's health care expenditures. STUDY DESIGN: A pre-post design with a comparison group was used to examine health status and health care expenditures for children involuntarily switching health plans relative to children already enrolled for 12 months or longer in the plan accepting the transfers. Overall health care expenditures as well as inpatient, emergency department, and outpatient expenditures were examined. Enrollment and claims data on 127,185 children (9,924 in the experiment group and 117,261 in the comparison group) from a states Medicaid program were employed. Children were grouped into nine Clinical Risk Group categories (such as healthy, malignancies, and catastrophic conditions) to characterize their health status. POPULATION STUDIED: Children involuntarily transferring to existing health plans due to the exit of their old plan and the established enrollees of existing plans. PRINCIPAL FINDINGS: In the experiment (comparison) group, 83% (81%) were healthy, 10% (12%) had chronic conditions, and 7 % (7%) had significant acute conditions. Multivariate models based on a difference-in-differences approach revealed that children who switched health plans involuntarily incurred higher total expenditures ($48.39 per member per month, PMPM) immediately following their transfer than established enrollees ($36.78 PMPM). Among children who switched health plans involuntarily, relative changes in post-transfer expenditures were larger for children with chronic conditions ($44.26 PMPM) than for healthy children ($5.36 PMPM). Expenditures related to emergency department and outpatient visits contributed to the higher post-transfer expenditures for children involuntarily switching plans. Health care expenditures incurred in the inpatient settings, however, were not different for the two groups of children. CONCLUSIONS: This study shows that enrollees who involuntarily switched health plans did not disproportionately have chronic conditions relative to the group of established enrollees in the health plans accepting the transferring children. However, expenditures on children who switched plans involuntarily were relatively high. The higher emergency department and outpatient expenditures may arise because the children change their usual source of care when they change health plan. The emergency department may provide the only immediate access to the health care system as families try to identify a new primary care provider (PCP) and learn new required procedures for accessing health care services. After the child and family identify a new PCP, the PCP may order additional health care services to assess the child and/or to address any unmet needs, leading to higher outpatient expenditures. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: States experiencing substantial exit of health plan might reduce health care costs and increase health care quality by implementing policies that help families to preserve familiar sources of care or to identify new PCPs promptly.
Publication Types:
Keywords:
- Child
- Gatekeeping
- Health Care Costs
- Health Expenditures
- Health Services
- Health Services Accessibility
- Health Services Needs and Demand
- Hospitals, Chronic Disease
- Humans
- Managed Care Programs
- Medicaid
- Quality of Health Care
- economics
- hsrmtgs
UI: 103623834
From Meeting Abstracts