Massachusetts children covered by Medicaid and enrolled in a health maintenance organization (HMO) were only half as likely as those in a State-administered primary care case manager (PCCM) plan to end up in the emergency department (ED) or be hospitalized for asthma. Furthermore, the HMO provided greater access to asthma specialists and more timely followup care after asthma ED visits than the PCCM plan, according to a study that was supported in part by the Agency for Healthcare Research and Quality (HS09327).
Alexandra E. Shields, Ph.D., of Georgetown University, and her colleagues analyzed Medicaid and HMO claims data and encounter data on 2,365 children enrolled in the Massachusetts Medicaid program in 1994. They used these data to assess performance on six pediatric asthma care measures, which were developed by the investigators, based on national guidelines. There were no differences between the HMO and the PCCM plan in asthma primary care visits, asthma medications, or followup care after asthma hospitalization. However, children in the HMO were only 54 percent as likely as those in the PCCM plan to have an asthma-related ED visit or hospitalization.
Children in the HMO plan had less severe asthma. However, after controlling for asthma severity and other factors affecting need for care, children in the HMO were nearly three times as likely as children in the PCCM plan to receive timely followup care (within 5 days) after an asthma ED visit, and they were nearly twice as likely to receive a specialist visit during the year.
More details are in "Comparing asthma care provided to Medicaid-enrolled children in a primary care case manager plan and a staff model HMO," by Dr. Shields, Catherine Comstock, M.P.H., Jonathan A. Finkelstein, M.D., M.P.H., and Kevin B. Weiss, M.D., M.P.H., in the September 2003 Ambulatory Pediatrics 3(5), pp. 253-262.
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