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Published on: November 9, 2016
Influence of Medicaid managed care enrollment on emergency department utilization by children
Kevin J Dombkowski1, Rachel Stanley, Sarah J Clark
1Child Health Evaluation and Research Unit, Division of General Pediatrics, University of Michigan, Ann Arbor, 48109-0456, USA. kjd@med.umich.edu
Insights
Children with full Medicaid managed care enrollment had the lowest emergency department (ED) use. Optimizing managed care plan enrollment can reduce ED visits for children in this population.
Area of Science:
- Health Services Research
- Pediatric Health
- Public Health Policy
Background:
- Medicaid managed care plans aim to control costs and improve care coordination for beneficiaries.
- Understanding the impact of enrollment duration in managed care on healthcare utilization is crucial for policy development.
Purpose of the Study:
- To investigate the relationship between the extent of enrollment in Medicaid managed care plans and emergency department (ED) utilization among children.
- To identify potential strategies for reducing unnecessary ED visits within the Medicaid population.
Main Methods:
- Retrospective cohort analysis of administrative claims data for 518,982 non-disabled children (ages 1-18) enrolled in Medicaid in 2000.
- Classified children based on the proportion of their enrollment months in managed care.
- Analyzed ED visit rates and used multivariate logistic regression to compare utilization for complex and non-complex services between groups with varying managed care enrollment.
Main Results:
- 22% of Medicaid-enrolled children had at least one ED visit in 2000, with 77% for non-complex services.
- Children enrolled in managed care for less than half their enrollment period showed significantly higher utilization of both complex (37% more) and non-complex (11% more) ED services compared to those fully enrolled.
- P-values <.001 indicated statistical significance for these differences.
Conclusions:
- Continuous enrollment in Medicaid managed care is associated with the lowest rates of emergency department utilization for both complex and non-complex services.
- Strategies to minimize delays or gaps in managed care plan enrollment may effectively reduce ED utilization among Medicaid-enrolled children.
Objective:
To explore the association between Medicaid managed care plan enrollment and emergency department (ED) utilization.
Design:
Retrospective cohort analysis using administrative claims data.
Participants:
A total of 518 982 nondisabled children 1 to 18 years of age who were Medicaid beneficiaries in calendar year 2000.
Main Outcome Measures:
Annual visit rates per 1000 member-months and incidence rate ratios for complex and noncomplex ED visits. Medicaid beneficiaries were classified on the basis of months enrolled in managed care. Administrative claims for ED visits were classified as complex or noncomplex on the basis of procedure and diagnostic codes. Multivariate logistic regression models of the incidence rate ratios were used to compare children with varying degrees of enrollment in Medicaid man-aged care with a reference group consisting of those exclusively enrolled in Medicaid managed care.
Results:
Overall, 22% of children receiving Medicaid made 1 or more ED visits in 2000; 77% of ED visits were for noncomplex services. Children who spent less than half of their enrolled months in managed care used complex ED services 37% more frequently (P<.001) and noncomplex services 11% more frequently (P<.001) than those exclusively enrolled in Medicaid managed care.
Conclusions:
Children with all of their Medicaid enrollment in managed care have the lowest ED utilization rates for complex and noncomplex services. These results suggest that reducing delays in managed care plan enrollment may be an effective strategy to reduce ED utilization for this population.
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