Comparing asthma care provided to medicaid-enrolled children in a Primary Care Case Manager plan and a staff model HMO

Objective. - To examine differences in selected processes of asthma care provided to Medicaid-enrolled children in a state-administered Primary Care Case Manager (PCCM) plan and a staff model health maintenance organization (HMO). Methods. - Retrospective cohort study assessing performance on 6 claims-based processes of care measures that reflect aspects of pediatric asthma care recommended in national guidelines. Analyzed Medicaid and HMO claims and encounter data for 2365 children with asthma in the Massachusetts Medicaid program in 1994. Results. - There were no plan differences in asthma primary care visits, asthma pharmacotherapy or follow-up care after asthma hospitalization. Children in the HMO were only 54% as likely (confidence interval [CI]: 0.37-0.80; P < .01) as those in the PCCM plan to experience an asthma emergency department (ED) visit or hospitalization. HMO-enrolled children were only half as likely (CI: 0.38-0.64; P < .001) to meet the National Committee for Quality Assurance (NCQA) definition for persistent asthma and only 32% as likely (CI: 0.19-0.56; P < .001) to have prior asthma ED visits or hospitalizations relative to children in the PCCM plan. Controlling for case mix and other covariates, children in the HMO were 2.9 times as likely (CI: 1.09-7.78; P < .05) as children in the PCCM plan to receive timely follow-up care (within 5 days) after an asthma ED visit and 1.8 times as likely (CI: 1.05-3.01; P < .05) as those in the PCCM plan to receive a specialist visit during the year. Conclusions. - In this study, the HMO served a less sick pediatric asthma population. After controlling for case mix, the staff model HMO provided greater access to asthma specialists and more timely follow-up care after asthma ED visits relative to providers in the state-administered PCCM plan. Further understanding of the impact of these differences on clinical outcomes could guide asthma improvement efforts.