TY - JOUR
T1 - Integrated, Accountable Care For Medicaid Expansion Enrollees
T2 - A Comparative Evaluation of Hennepin Health
AU - Vickery, Katherine D.
AU - Shippee, Nathan D.
AU - Menk, Jeremiah
AU - Owen, Ross
AU - Vock, David M.
AU - Bodurtha, Peter
AU - Soderlund, Dana
AU - Hayward, Rodney A.
AU - Davis, Matthew M.
AU - Connett, John
AU - Linzer, Mark
N1 - Funding Information:
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The authors would like to acknowledge financial support for this work from The Commonwealth Fund (grant number 20140726) and the National Center for Advancing Translational Sciences of the National Institutes of Health (grant number UL1TR000114).
Funding Information:
We acknowledge partnership and support from the Minnesota Department of Human Services in provision of data and technical assistance with data management. We acknowledge support in the early design and conceptualization of this work and formatting of the data from Doug Wholey and Rob Kreiger. We acknowledge support for preparation of this article and coordination of this project from Laura Guzman-Corrales and Melissa Adkins. The author(s) received no financial support for the research, authorship, and/or publication of this article.
Publisher Copyright:
© The Author(s) 2018.
PY - 2020/2/1
Y1 - 2020/2/1
N2 - Hennepin Health, a Medicaid accountable care organization, began serving early expansion enrollees (very low-income childless adults) in 2012. It uses an integrated care model to address social and behavioral needs. We compared health care utilization in Hennepin Health with other Medicaid managed care in the same area from 2012 to 2014, controlling for demographics, chronic conditions, and enrollment patterns. Homelessness and substance use were higher in Hennepin Health. Overall adjusted results showed Hennepin Health had 52% more emergency department visits and 11% more primary care visits than comparators. Over time, modeling a 6-month exposure to Hennepin Health, emergency department and primary care visits decreased and dental visits increased; hospitalizations decreased nonsignificantly but increased among comparators. Subgroup analysis of high utilizers showed lower hospitalizations in Hennepin Health. Integrated, accountable care under Medicaid expansion showed some desirable trends and subgroup benefits, but overall did not reduce acute health care utilization versus other managed care.
AB - Hennepin Health, a Medicaid accountable care organization, began serving early expansion enrollees (very low-income childless adults) in 2012. It uses an integrated care model to address social and behavioral needs. We compared health care utilization in Hennepin Health with other Medicaid managed care in the same area from 2012 to 2014, controlling for demographics, chronic conditions, and enrollment patterns. Homelessness and substance use were higher in Hennepin Health. Overall adjusted results showed Hennepin Health had 52% more emergency department visits and 11% more primary care visits than comparators. Over time, modeling a 6-month exposure to Hennepin Health, emergency department and primary care visits decreased and dental visits increased; hospitalizations decreased nonsignificantly but increased among comparators. Subgroup analysis of high utilizers showed lower hospitalizations in Hennepin Health. Integrated, accountable care under Medicaid expansion showed some desirable trends and subgroup benefits, but overall did not reduce acute health care utilization versus other managed care.
KW - Medicaid expansion
KW - accountable care organization
KW - integrated care models
KW - marginal structural models
KW - social determinants of health
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U2 - 10.1177/1077558718769481
DO - 10.1177/1077558718769481
M3 - Article
C2 - 29749302
AN - SCOPUS:85046831311
SN - 1077-5587
VL - 77
SP - 46
EP - 59
JO - Medical Care Research and Review
JF - Medical Care Research and Review
IS - 1
ER -
