Autorzy: Charles Michalopoulos, Michelle Manno, Tod Mijanovich, Susanna Ginsburg, Jennifer Somers
Tytuł: The New York Chronic Illness Demonstration Project Final Report on an Evaluation of Six Pilot Coordinated Care Projects for High-Needs Medicaid Recipients
Opublikowane: August 2014
Streszczenie: Coordinated care programs are designed to assist individuals with multiple chronic conditions who might require attention from several doctors, risking duplicative tests or prescriptions for contraindicated medications. Such programs try to reduce these risks by helping individuals optimize their use of the health care system and represent an important policy tool for high-needs Medicaid recipients. In 2007, the New York State legislature approved funding for the Chronic Illness Demonstration Project (CIDP) to provide coordinated care to chronically ill Medicaid recipients. In 2009, six CIDP projects began providing services to individuals with a high likelihood of being hospitalized. The projects used care managers to assess clients’ health care and social service needs, educate them on their medical conditions, coordinate care across providers, and help them make and keep medical appointments. Projects also attempted to facilitate individuals’ access to appropriate care. The state’s goal was to help individuals use more primary and preventive care, in turn reducing emergency room and hospital use and helping to control Medicaid costs. This report presents results of a study of CIDP conducted by MDRC. The study had two components: an impact analysis of the effects of the projects on health care used through Medicaid, and an implementation analysis of the services provided and challenges faced by the projects.
Key Findings. The projects faced a number of challenges implementing the program. Effective working relationships with other providers and timely information on hospitalization and emergency department visits were difficult to obtain. In addition, inaccurate contact information and residential instability made it difficult to find and enroll individuals in services. Because only 10 percent of eligible individuals enrolled, staff spent time and resources building relationships with a large number of community partners in an effort to locate and serve eligible Medicaid recipients. The program did not appear to reduce Medicaid costs or care from hospitals and emergency departments. The frequency of primary care visits, hospital admissions, emergency department visits, and use of prescription medications were similar for CIDP-eligible Medicaid recipients and a control group. If anything, the program appeared to increase Medicaid costs slightly, reflecting the costs of providing coordinated care. The projects could have been improved in several ways. More effective programs have had frequent in-person contact, focused on the transition from hospital to home, and had close interaction between care managers and primary care providers. No CIDP project adopted all these principles. There was variation across projects in most of these areas, although in general they came closer to meeting these standards than did other recent demonstrations. Although the results suggest the program had little effect on Medicaid costs in its first two years, it is possible that the effects would have emerged after the second year. It is also possible that the program increased the quality of care, the use of social services, or patient satisfaction with care, but the study did not measure these variables.
Tagi: Medicaid. Coordinated care. High-cost patients.