Short-Term Medicaid Utilization Associated With an Advanced Primary Care Model

Area of Science:

• Pediatric primary care innovation
• Health services research
• Medicaid policy

Background:

• Advanced primary care models show promise for addressing pediatric and family needs.
• Current Medicaid payment structures present challenges to the short-term sustainability of these models.
• Evaluating claims-based outcomes is crucial for understanding the impact of novel care delivery systems.

Purpose of the Study:

• To evaluate the claims-based outcomes of the 3-2-1 IMPACT (IMPACT) early childhood advanced primary care model.
• To compare IMPACT model outcomes against the standard of care within a Medicaid population.
• To assess the short-term sustainability of an advanced primary care model under existing payment structures.

Main Methods:

• Utilized New York State Medicaid claims data for children aged 1 to 35 months.
• Matched children receiving care at 3 IMPACT sites with children from 3 comparison sites within a public hospital system.
• Employed regression models to analyze differences in use, expenditure, enrollment, and quality outcomes.

Main Results:

• The IMPACT model was associated with a significant increase in well-child visits (≥6) and a decrease in emergency department visit rates.
• Specifically, Black and Hispanic children at IMPACT sites showed a significant increase in well-child visits compared to controls.
• No significant differences were observed in expenditures, other healthcare utilization, or Medicaid enrollment between the groups.

Conclusions:

• Early childhood advanced primary care models integrating evidence-based programs can yield short-term improvements in preventative and acute care use and quality within Medicaid.
• These findings offer insights into short-term sustainability strategies for advanced primary care models.
• Further research is warranted to explore the long-term effects and specific component impacts of models like IMPACT on dyadic and socio-emotional outcomes.