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Effects of forced disruption in Medicaid managed care on children with asthma
Katherine Piwnica-Worms1,2, Becky Staiger3, Joseph S Ross4,5,6,7
1Department of Pediatrics, NYU Langone School of Medicine, New York, New York, USA.
Insights
Forced changes in Medicaid managed care plans reduced outpatient visits for children with persistent asthma. However, these disruptions did not negatively impact asthma care quality or emergency healthcare use.
Area of Science:
- Health Services Research
- Pediatric Asthma Management
- Managed Care Policy
Background:
- Medicaid managed care plans are crucial for children's health access.
- Disruptions to these plans can affect healthcare utilization and outcomes.
- Understanding the impact on children with persistent asthma is vital for policy evaluation.
Purpose of the Study:
- To assess how forced changes in Medicaid managed care plans and provider networks influence health utilization and outcomes for children with persistent asthma.
- To analyze the effects of patient redistribution among managed care plans on healthcare access and quality for this vulnerable population.
Main Methods:
- Utilized administrative claims data from a southeastern state (2013-2016).
- Employed a difference-in-difference analysis comparing pre- and post-redistribution periods.
- Linked enrollment data for children with persistent asthma to administrative claims for continuous enrollment analysis.
Main Results:
- 26% of children with persistent asthma were forced to switch managed care plans, with 67% also changing primary care providers.
- Disruption was linked to a 2.1 percentage-point decrease in quarterly outpatient visits.
- While asthma-specific visits decreased overall, the reduction was less pronounced for children who also switched primary care providers.
Conclusions:
- Forced disruption of Medicaid managed care plans led to fewer outpatient visits for children with persistent asthma.
- No significant negative associations were found with asthma care quality indicators or emergency healthcare utilization.
- Policy changes affecting managed care enrollment require careful consideration of potential impacts on healthcare access for pediatric populations.
Objective:
To evaluate the effect of a forced disruption to Medicaid managed care plans and provider networks on health utilization and outcomes for children with persistent asthma.
Data Sources:
Medicaid managed care administrative claims data from 2013 to 2016, obtained from a southeastern state.
Study Design:
A difference-in-difference analysis compared patients' outpatient, inpatient, and emergency department (ED) utilization and receipt of recommended services before and after implementation of a statewide redistribution of patients among nine managed care plans.
Data Collection/Extraction Methods:
Enrollment data for children with asthma were linked to the administrative claims. Children were included if they had a diagnosis of persistent asthma in 2013 and if they were enrolled continuously throughout 2014-2016.
Principal Findings:
Among the 28 537 children with asthma, 26% were forced to switch their managed care plan after the redistribution. Of these, 67% also switched their primary care provider (PCP). Relative to those who remained in their plan, disruption was associated with an additional 2.1 percentage-point decrease in the number of children who had an outpatient visit per quarter [95%CI -2.8, -1.3], from 71% to 66% (compared to plan stayers: 74% to 71%). Among children experiencing a change to their plan, there was overall a decrease in the proportion of children receiving an asthma-specific visit per quarter, but there was less of a decrease in children that also changed their PCP [1.6 percentage points, 95%CI 0.7, 2.5], from 9.7% to 8.3% (compared to those who did not switch their PCP: 12% to 8.6%). Indicators of asthma care quality and emergent care utilization were not significantly different between the two periods.
Conclusions:
While there was a decrease in the number of outpatient visits associated with forced disruption of Medicaid managed care plans for children with persistent asthma, there were no consistent associations with worse asthma quality performance or higher emergent health care utilization.
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