Introduction The Medicaid Health Home (MHH) program began on July 1, 2012 with 308 members. This program is designed to enhance services to Medicaid members with chronic conditions through provider implementation of Patient-Centered Medical Home best practices. Providers are paid to provide these enhanced services through per member per month payment based on the member’s number of chronic conditions. Currently, there are 31 counties with MHH providers.
Methods The study population is composed of two Medicaid member groups: those participating in the MHH (MHH members) and a randomly selected group of matched non-MHH members. The total number of members in the study was 25,118 with 3,510 MHH members and 21,608 non-MHH members. Non-MHH members were matched to members by decade of birth, gender and type of program for the final 30 months of the study on a month by month basis. MHH members were more likely to be enrolled longer in Medicaid during the study period. Sixty percent were enrolled for all 36 months, while only 47% of non-MHH members were enrolled for the entire study period. MHH members were more likely to be female and more likely to be middle aged. Outcome rates were calculated for both groups and compared over the three year study period.
Ambulatory care MHH members had an increase in outpatient visits over the 3 year period while those not in the MHH had little change in outpatient visit rates. ED visit rates varied by tier, with those in tier 2 and 3 having a decrease in the ED visit rate, while the rate for those in tier 1 remained constant and the rate for those in tier 4 increased. The rate of ED use increased for non-MHH members. The effect of tier may indicate that there are levels of chronic illness that are impacted more significantly by the MHH.
Nursing facility utilization Though there were few nursing facility admissions, the general pattern of admissions for the two groups resulted in a decrease in the rate of intermediate facility admissions for the MHH group while this rate increased for the non-MHH group. The admission rate for skilled nursing facilities increased similarly in both groups.
Hospital Readmissions There were too few readmissions within 30 days to allow for risk adjustment, therefore, we report the numbers of readmissions for the MHH group over the three year period, with regard to diagnosis. Diabetes was the most common primary diagnosis for readmissions in the MHH group ranging from 13 in CY 2011 to 17 in CY 2013. Other diagnoses on readmission included Anemia, asthma, and electrolyte imbalance.
Primary Care The rates of preventive care use decreased in both groups for those ages 20-64 over the three year period. Rates of primary care use remained high and stable in the MHH group while it decreased in the non-MHH group. Finally, the ambulatory care/office visit rate remained the same for the MHH group while it declined in the non-MHH group.
Conclusion This report details outcome results over a three year period that encompasses 18 months before through 18 months after the MHH program began. The results are preliminary as this program is still maturing, adding new members and providers. There are some indicators that point to successes in the program such as the decrease in ED use for some MHH members and the reduction in intermediate care facility admissions, yet others may indicate that the program can be improved such as the low preventive visit rate and the stable number of hospital readmissions.
health home programs, Iowa
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