Journal article
Quality of Care for Chronic Conditions Among Disabled Medicaid Enrollees An Evaluation of a 1915 (b) and (c) Waiver Program
Medical care, Vol.53(7), pp.599-606
07/01/2015
DOI: 10.1097/MLR.0000000000000371
PMCID: PMC4510474
PMID: 26035044
Abstract
Importance:Examining the impact of Medicaid-managed care home-based and community-based service (HCBS) alternatives to institutional care is critical given the recent rapid expansion of these models nationally.Objective:We analyzed the effects of STAR+PLUS, a Texas Medicaid-managed care HCBS waiver program for adults with disabilities on the quality of chronic disease care.Design, Setting, and Participants:We compared quality before and after a mandatory transition of disabled Medicaid enrollees older than 21 years from fee-for-service (FFS) or primary care case management (PCCM) to STAR+PLUS in 28 counties, relative to enrollees in counties remaining in the FFS or PCCM models.Measures and Analysis:Person-level claims and encounter data for 2006-2010 were used to compute adherence to 6 quality measures. With county as the independent sampling unit, we employed a longitudinal linear mixed-model analysis accounting for administrative clustering and geographic and individual factors.Results:Although quality was similar among programs at baseline, STAR+PLUS enrollees experienced large and sustained improvements in use of -blockers after discharge for heart attack (49% vs. 81% adherence posttransition; P<0.01) and appropriate use of systemic corticosteroids and bronchodilators after a chronic obstructive pulmonary disease event (39% vs. 68% adherence posttransition; P<0.0001) compared with FFS/PCCM enrollees. No statistically significant effects were identified for quality measures for asthma, diabetes, or cardiovascular disease.Conclusion:In 1 large Medicaid-managed care HCBS program, the quality of chronic disease care linked to acute events improved while that provided during routine encounters appeared unaffected.
Details
- Title: Subtitle
- Quality of Care for Chronic Conditions Among Disabled Medicaid Enrollees An Evaluation of a 1915 (b) and (c) Waiver Program
- Creators
- Martin P. Wegman - Aetna (United States)Jill B. Herndon - Univ Florida, Dept Hlth Outcomes & Policy, Gainesville, FL 32610 USAKeith E. Muller - Univ Florida, Dept Hlth Outcomes & Policy, Gainesville, FL 32610 USAGarth N. Graham - Aetna Fdn, Hartford, CT USAW. Bruce Vogel - Univ Florida, Dept Hlth Outcomes & Policy, Gainesville, FL 32610 USAKimberly H. Case - Univ Florida, Dept Hlth Outcomes & Policy, Gainesville, FL 32610 USAJason A. Lee - Univ Florida, Dept Hlth Outcomes & Policy, Gainesville, FL 32610 USAMatthew F. Van Voorhis - Univ Florida, Dept Hlth Outcomes & Policy, Gainesville, FL 32610 USAElizabeth A. Shenkman - Univ Florida, Dept Hlth Outcomes & Policy, Gainesville, FL 32610 USA
- Resource Type
- Journal article
- Publication Details
- Medical care, Vol.53(7), pp.599-606
- DOI
- 10.1097/MLR.0000000000000371
- PMID
- 26035044
- PMCID
- PMC4510474
- NLM abbreviation
- Med Care
- ISSN
- 0025-7079
- eISSN
- 1537-1948
- Publisher
- Lippincott Williams & Wilkins
- Number of pages
- 8
- Grant note
- F30MH105153 / NATIONAL INSTITUTE OF MENTAL HEALTH; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of Mental Health (NIMH) TL1 TR000066; UL1 TR000064 / NIH/NCATS; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Center for Advancing Translational Sciences (NCATS) UL1TR001427 / NATIONAL CENTER FOR ADVANCING TRANSLATIONAL SCIENCES; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Center for Advancing Translational Sciences (NCATS)
- Language
- English
- Date published
- 07/01/2015
- Academic Unit
- Public Policy Center (Archive)
- Record Identifier
- 9984283852502771
Metrics
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