Early impact of the implementation of Medicaid episode‐based payment reforms in Arkansas

Autor:	Suzanne L. West, Paul Moore, Matt Toth, Nathan West, Elizabeth Tant, Heather Beil, Sam Arbes, Regina Rutledge
Rok vydání:	2020
Předmět:	Adult Male medicine.medical_specialty Episode of Care Population Group B 03 medical and health sciences 0302 clinical medicine Pregnancy medicine Humans 030212 general & internal medicine education Respiratory Tract Infections Aged Retrospective Studies Aged 80 and over education.field_of_study Arkansas Respiratory tract infections Medicaid business.industry 030503 health policy & services Health Policy Medicare and Medicaid Respiratory infection Fee-for-Service Plans Emergency department Middle Aged medicine.disease United States Pharyngitis Hospitalization Perinatal Care Cross-Sectional Studies Emergency medicine Female medicine.symptom Emergency Service Hospital 0305 other medical science business
Zdroj:	Health Serv Res
ISSN:	1475-6773 0017-9124
DOI:	10.1111/1475-6773.13296
Popis:	OBJECTIVE: To evaluate episode‐based payments for upper respiratory tract infections (URI) and perinatal care in Arkansas's Medicaid population. STUDY SETTING: Upper respiratory infection and perinatal episodes among Medicaid‐covered individuals in Arkansas and comparison states from fiscal year (FY) 2011 to 2014. STUDY DESIGN: Cross‐sectional observational analysis using a difference‐in‐difference design to examine outcomes associated with URI and perinatal episodes of care (EOC) from 2011 to 2014. Key dependent variables include antibiotic use, emergency department visits, physician visits, hospitalizations, readmission, and preventive screenings. DATA COLLECTION: Claims data from the Medicaid Analytic Extract for Arkansas, Mississippi, and Missouri from 2010 to 2014 with supplemental county‐level data from the Area Health Resource File (AHRF). PRINCIPAL FINDINGS: The URI EOC reduced the probability of antibiotic use (marginal effect [ME] = −1.8, 90% CI: −2.2, −1.4), physician visits (ME = 0.6, 90% CI: −0.8, −0.4), improved the probability of strep tests for children diagnosed with pharyngitis (ME = 9.4, 90% CI: 8.5, 10.3), but also increased the probability of an emergency department (ED) visit (ME = 0.1, 90% CI: 0.1, 0.2), relative to the comparison group. For perinatal EOCs, we found a reduced probability of an ED visit during pregnancy (ME = 0.1, 90% CI: −0.2, −0.0), an increased probability of screening for HIV (ME = 6.2, 90% CI: 4.0, 8.5), chlamydia (ME = 9.5, 90% CI: 7.2, 11.8), and group B strep‐test (ME = 2.6, 90% CI: 0.5, 4.6), relative to the comparison group. Predelivery and postpartum hospitalizations also increased (ME = 1.2, 90% CI: 0.4, 2.0; ME = 0.4, 90% CI: 0.0, 0.8, respectively), relative to the comparison group. CONCLUSION: Upper respiratory infection and perinatal EOCs for Arkansas Medicaid beneficiaries produced mixed results. Aligning shared savings with quality metrics and cost‐thresholds may help achieve quality targets and disincentivize over utilization within the EOC, but may also have unintended consequences.
Databáze:	OpenAIRE
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