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The effect of disease management on utilization of services by race/ethnicity: evidence from the Florida Medicaid
Gerald F Kominski1, Donald E Morisky, Abdelmonem A Afifi
1School of Public Health, University of California, Los Angeles, 10960 Wilshire Blvd, Ste 1550, Los Angeles, CA 90024, USA. kominski@ucla.edu
Objective:
To measure possible racial/ethnic differences in a Florida disease management (DM) program on utilization of selected healthcare services for 4 chronic illnesses.
Study Design:
Pre-post comparison of utilization among 15,275 high-risk beneficiaries enrolled in DM in the Florida Medicaid program between October 2001 and October 2003.
Methods:
Two-part regression analyses of the effect of DM on annualized inpatient days, emergency department (ED) visits, and outpatient visits, controlling for relevant covariates. Annualized rates were used to adjust for differences in length of program enrollment.
Results:
Disease management patients in the postperiod had significantly lower annual rates of inpatient days, ED visits, and outpatient visits across most racial/ethnic groups. Disease management reduced utilization by a similar absolute amount in each racial/ethnic group. However, baseline disparities in utilization of inpatient days were not reduced by the DM program.
Conclusions:
Disease management has a similar effect across different racial/ethnic groups but may not ameliorate important baseline disparities. Evaluations of DM programs should account for baseline disparities in utilization and examine whether those disparities can be reduced through DM.
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