Changes in Quality of Life Among Enrollees in Hennepin Health: A Medicaid Expansion ACO

Abstract

Despite limited program evaluations of Medicaid accountable care organizations (ACOs), no studies have examined if cost-saving goals negatively affect quality of life and health care experiences of low-income enrollees. The Hennepin Health ACO uses an integrated care model to address the physical, behavioral, and social needs of Medicaid expansion enrollees. As part of a larger evaluation, we conducted semistructured interviews with 35 primary care using Hennepin Health members enrolled for 2 or more years. Using fuzzy set qualitative comparative analysis, we assessed enrollee complexity and use of the care model and improvements in quality of life. We found improved quality of life was consistently associated with strong bonds to primary care, consistent mental health care, and support from extended care team members. Comprehensive, integrated care models within ACOs may improve quality of life for low-income Medicaid enrollees through coordinated primary and mental health care.

Medicaid Accountable Care Organizations in Four States: Implementation and Early Impacts

“…Also, it is the first to examine states’ implementation of Medicaid ACOs over time, which provides important context for interpreting impact results. This study expands the evidence on Medicaid ACO performance beyond previous work by McConnell and colleagues examining Medicaid coordinated care organizations in Oregon, a global budgeting model, that found reductions in expenditures relative to a neighboring state but no reductions in expenditures compared with a state that implemented a regionally based accountable care model, and no evidence on quality of life impacts following implementation of a capitated managed care/ACO hybrid …”

Experiences with Work and Participation in Public Programs by Low-Income Medicaid Enrollees Using Qualitative Interviews

“…16,17 Participants had varied work histories during the study period; only three had had full-time employment. 12 We identified eight themes related to work, which fit into three broad domains: (I) contexts of people's lives complicating their ability to work; (II) experiences with work; (III) experiences with public programs (Table 2). All participants described critical poverty-low/no income creating severe deprivation-by detailing their daily struggles meeting basic needs and "living check to check."…”

“…We interviewed very low-income early Medicaid expansion enrollees participating in a county-sponsored Medicaid managed care plan as a part of a larger study. 12 These Medicaid expansion enrollees, at the time, were adults without dependents earning < 75% of the federal poverty limit. While income-based Medicaid eligibility in Minnesota now matches the national average, Minnesota spends~$1500 more than the US average per adult enrollee.…”

“…This method emphasizes a comprehensive understanding of a person's life, using framing questions that empower interviewees to direct their narratives uninterruptedly. 12 Interview participants signed consent for access to their medical and social service records. 12 Interviewers completed structured training.…”

“…12 Interview participants signed consent for access to their medical and social service records. 12 Interviewers completed structured training. Question guides included physical and behavioral health conditions, social history, experience using health care and social services, work history, and use of employment and income support programs, including state and federal disability programs.…”