Factors associated with persistent high health care utilization in managed Medicaid
| Autor: | Amy Alabaster, Somalee Banerjee, Alyce S. Adams, Patricia Kipnis |
|---|---|
| Rok vydání: | 2021 |
| Předmět: |
Adult
medicine.medical_specialty education.field_of_study Medicaid managed care business.industry Medicaid Health Policy Population Managed Care Programs Retrospective cohort study Patient Acceptance of Health Care Medicare United States Integrated care Relative risk Health care Emergency medicine Cohort medicine Humans business education Aged Retrospective Studies |
| Zdroj: | The American journal of managed care. 27(8) |
| ISSN: | 1936-2692 |
| Popis: | Objectives Prior studies have had difficulty predicting which patients will have persistent high utilization past 1 year within the Medicaid population. The objective of this study was to examine the medical diagnoses at the time of enrollment of patients with persistent high health care utilization over 24 months following enrollment in Medicaid managed care in a large integrated care setting. Study design Retrospective cohort study in a large integrated managed health care system. Methods We identified a cohort of high utilizers (top 5% of health care costs in 2014) and extracted their electronic health record data (2014-2016). Differences in baseline characteristics of high utilizers and the general Medicaid population were determined using bivariate analysis. We used multivariable regression to determine the independent association between medical comorbidities and demographics with persistent high health care utilization over the 2 years following enrollment. Results Compared with the general Medicaid managed care enrollee population, schizophrenia was the only mental health diagnosis at the time of enrollment associated with persistent high health care utilization (risk ratio [RR], 1.50; 95% CI, 1.20-1.86). Additional characteristics associated with persistent high utilization included age between 31 and 50 years (RR, 1.20; 95% CI, 1.02-1.41), dual enrollment in Medicaid and Medicare (RR, 1.26; 95% CI, 1.09-1.45), chronic pain diagnoses (RR, 1.26; 95% CI, 1.04-1.53), and multimorbidity (RR, 1.43; 95% CI, 1.25-1.63). Conclusions Among adults newly enrolled in Medicaid managed care, certain diagnoses noted at the time of enrollment into the plan are associated with persistent high health care utilization over the first 2 years, suggesting that targeting early supportive case management to these individuals could optimize care and reduce health care costs. |
| Databáze: | OpenAIRE |
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