Hughes R, Starfield B, Burstin H; AcademyHealth. Meeting (2004 : San Diego, Calif.).

Abstr AcademyHealth Meet. 2004; 21: abstract no. 1016.

Agency for Healthcare Research and Quality, Center for Primary Care, Prevention, and Clinical Partnerships, 540 Gaither Road, Rockville, MD 20852 Tel. 301.427.1578 Fax 301.427.1595

RESEARCH OBJECTIVE: This multi-state study evaluates the impact of Medicaid managed care on resource utilization among adult beneficiaries with diabetes by type of Medicaid eligibility and sets forth the methodological challenges in using claims data from multiple states. It is hypothesized that as patients move into managed care arrangements, the clinical detail of the administrative data diminishes, therefore limiting the ability to assess the quality of care. STUDY DESIGN: This study uses State Medicaid Research Files (SMRF) maintained by the Centers for Medicare and Medicaid Services for 1996 through 1998, to assess outpatient and inpatient utilization among all adult Medicaid beneficiaries, age 18 and over. This includes patients that qualify for Medicaid services under the Aid for Families with Dependent Children (now Section 1931 eligibility) income provisions, the blind and disabled part including Supplemental Security Income (SSI), and the aged provisions of the Medicaid program. SMRF data were used to assess the diagnostic information associated with specific health care services, including rates of hospitalizations for diabetes and other conditions, diabetic measures including use of injectibles and oral hypoglycemics, utilization of outpatient services, and co-morbidities. Diabetic patients were identified if they had at least two diagnoses for diabetes during the year. Diabetic adult beneficiaries were further stratified by: 1.) length of enrollment in Medicaid (e.g., individuals enrolled in Medicaid 0 5 months, 6 to 12 months, and at least 12 continuous months); 2.) enrollment in managed care or fee-for-service (FFS); and 3.) type of eligibility (e.g., AFDC, blind and disabled non elderly, and elderly). POPULATION STUDIED: Adult Medicaid beneficiaries with diabetes. PRINCIPAL FINDINGS: Using available data, this study found that frequencies of receipt of care for diabetics was limited by whether Medicaid patients were in managed care. Hospitalization rates with a primary diagnosis of diabetes ranged from 8.1 to 364.9 and the average number of emergency department visits was 2.6. Utilization differences in hemoglobin A1c measurement at least once in 12 months or a lipid profile in the past two years varied among sub-populations and states by as much as 22.6 percent. Hospitalizations, emergency department visits, and rates and having a retinal eye exam increased with age and number of co-morbidities. There were significant variations in number of outpatient visits and type of services utilized among the different enrollee groups, associated with the completeness of the clinical content of the data. CONCLUSIONS: As the clinical content of the SMRF for outpatient services was limited, findings must be interpreted cautiously. The methodological issues involved in using the Medicaid claims data for purposes of government oversight and quality of care improvement initiatives can prohibit use of the data for assessing the quality of care if outpatient data is available for only certain Medicaid sub-populations. Managed care penetration, effects the ability to examine utilization for diabetics due to data availability. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: The implications of these findings for health care policy and future research will be discussed, including future research using state maintained Medicaid claims files as well as implications for investigation of utilization among dual eligibles and individuals with multiple chronic conditions.

Publication Types:

• Meeting Abstracts

Keywords:

• Adult
• Aged
• Ambulatory Care
• Centers for Medicare and Medicaid Services (U.S.)
• Child
• Diabetes Mellitus
• Diabetes Mellitus, Type 2
• Disabled Persons
• Eligibility Determination
• Health Services
• Health Services Accessibility
• Hospitalization
• Humans
• Managed Care Programs
• Medicaid
• Medicare
• economics
• utilization
• hsrmtgs

UI: 103624050

From Meeting Abstracts