Comparing asthma care provided to Medicaid-enrolled children in a Primary Care Case Manager plan and a staff model HMO
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Published on: November 4, 2010
Alexandra E Shields1, Catherine Comstock, Jonathan A Finkelstein
1Health Policy Institute, Georgetown University, Washington, DC 20007, USA. shieldsa@georgetown.edu
Insights
Children in a health maintenance organization (HMO) experienced fewer asthma emergency visits and hospitalizations compared to those in a Primary Care Case Manager (PCCM) plan. The HMO also provided better access to asthma specialists and timely follow-up care for pediatric asthma patients.
Area of Science:
- Pediatric Asthma Care
- Health Services Research
- Comparative Healthcare Effectiveness
Background:
- Asthma management for children enrolled in Medicaid requires effective care delivery models.
- Comparing care processes between different healthcare systems, such as Health Maintenance Organizations (HMOs) and Primary Care Case Manager (PCCM) plans, is crucial for identifying best practices.
Purpose of the Study:
- To compare the quality of asthma care processes between children with asthma enrolled in a state-administered PCCM plan and a staff model HMO.
- To identify differences in the utilization of asthma-related services and adherence to national guidelines.
Main Methods:
- A retrospective cohort study analyzed claims and encounter data for 2365 children with asthma in the Massachusetts Medicaid program in 1994.
- Six claims-based process of care measures, reflecting national pediatric asthma care guidelines, were assessed.
Main Results:
- No significant differences were found in primary care visits, asthma pharmacotherapy, or post-hospitalization follow-up care.
- Children in the HMO experienced fewer asthma emergency department (ED) visits or hospitalizations (54% as likely) compared to the PCCM plan.
- HMO-enrolled children were less likely to meet criteria for persistent asthma and had fewer prior ED visits/hospitalizations.
- After adjusting for case mix, HMO enrollees received more timely follow-up care after ED visits (2.9 times as likely) and had greater access to specialists (1.8 times as likely).
Conclusions:
- The study suggests the HMO served a less severely ill pediatric asthma population.
- Staff model HMOs demonstrated superior performance in providing timely follow-up care post-ED visits and facilitating access to asthma specialists compared to the PCCM plan.
- Further research is needed to understand the clinical outcome implications of these care delivery differences to inform asthma improvement initiatives.
Objective:
To examine differences in selected processes of asthma care provided to Medicaid-enrolled children in a state-administered Primary Care Case Manager (PCCM) plan and a staff model health maintenance organization (HMO).
Methods:
Retrospective cohort study assessing performance on 6 claims-based processes of care measures that reflect aspects of pediatric asthma care recommended in national guidelines. Analyzed Medicaid and HMO claims and encounter data for 2365 children with asthma in the Massachusetts Medicaid program in 1994.
Results:
There were no plan differences in asthma primary care visits, asthma pharmacotherapy or follow-up care after asthma hospitalization. Children in the HMO were only 54% as likely (confidence interval [CI]: 0.37-0.80; P<.01) as those in the PCCM plan to experience an asthma emergency department (ED) visit or hospitalization. HMO-enrolled children were only half as likely (CI: 0.38-0.64; P<.001) to meet the National Committee for Quality Assurance (NCQA) definition for persistent asthma and only 32% as likely (CI: 0.19-0.56; P<.001) to have prior asthma ED visits or hospitalizations relative to children in the PCCM plan. Controlling for case mix and other covariates, children in the HMO were 2.9 times as likely (CI: 1.09-7.78; P<.05) as children in the PCCM plan to receive timely follow-up care (within 5 days) after an asthma ED visit and 1.8 times as likely (CI: 1.05-3.01; P<.05) as those in the PCCM plan to receive a specialist visit during the year.
Conclusions:
In this study, the HMO served a less sick pediatric asthma population. After controlling for case mix, the staff model HMO provided greater access to asthma specialists and more timely follow-up care after asthma ED visits relative to providers in the state-administered PCCM plan. Further understanding of the impact of these differences on clinical outcomes could guide asthma improvement efforts.
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