Coordinated Care Organizations and mortality among low‐income infants in Oregon

Bui, Linh; Yoon, Jangho; Harvey, S. Marie; Luck, Jeff

doi:10.1111/1475-6773.13228

Cited by 3 publications

(2 citation statements)

References 31 publications

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“…Early pediatric ACOs have shown promise in increasing preventive services and reducing costs . However, designs have varied widely, with few published reports.…”

Section: Introductionmentioning

confidence: 99%

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Analysis of North Carolina Medicaid Claims Data to Simulate a Pediatric Accountable Care Organization

Cholera,

Anderson,

Chung

et al. 2023

JAMA Netw Open

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ImportanceDespite momentum for pediatric value-based payment models, little is known about tailoring design elements to account for the unique needs and utilization patterns of children and young adults.ObjectiveTo simulate attribution to a hypothetical pediatric accountable care organization (ACO) and describe baseline demographic characteristics, expenditures, and utilization patterns over the subsequent year.Design, Setting, and ParticipantsThis retrospective cohort study used Medicaid claims data for children and young adults aged 1 to 20 years enrolled in North Carolina Medicaid at any time during 2017. Children and young adults receiving at least 50% of their primary care at a large academic medical center (AMC) in 2017 were attributed to the ACO. Data were analyzed from April 2020 to March 2021.Main Outcomes and MeasuresPrimary outcomes were total cost of care and care utilization during the 2018 performance year.ResultsAmong 930 266 children and young adults (377 233 children [40.6%] aged 6-12 years; 470 612 [50.6%] female) enrolled in Medicare in North Carolina in 2017, 27 290 children and young adults were attributed to the ACO. A total of 12 306 Black non-Hispanic children and young adults (45.1%), 6308 Hispanic or Latinx children and young adults (23.1%), and 6531 White non-Hispanic children and young adults (23.9%) were included. Most attributed individuals (23 133 individuals [84.7%]) had at least 1 claim in the performance year. The median (IQR) total cost of care in 2018 was $347 ($107-$1123); 272 individuals (1.0%) accounted for nearly half of total costs. Compared with children and young adults in the lowest-cost quartile, those in the highest-cost quartile were more likely to have complex medical conditions (399 individuals [6.9%] vs 3442 individuals [59.5%]) and to live farther from the AMC (median [IQR distance, 6.0 [4.6-20.3] miles vs 13.9 [4.6-30.9] miles). Total cost of care was accrued in home (43%), outpatient specialty (19%), inpatient (14%) and primary (8%) care. More than half of attributed children and young adults received care outside of the ACO; the median (IQR) cost for leaked care was $349 ($130-$1326). The costliest leaked encounters included inpatient, ancillary, and home health care, while the most frequently leaked encounters included behavioral health, emergency, and primary care.Conclusions and RelevanceThis cohort study found that while most children attributed to the hypothetical Medicaid pediatric ACO lived locally with few health care encounters, a small group of children with medical complexity traveled long distances for care and used frequent and costly home-based and outpatient specialty care. Leaked care was substantial for all attributed children, with the cost of leaked care being higher than the total cost of care. These pediatric-specific clinical and utilization profiles have implications for future pediatric ACO design choices related to attribution, accounting for children with high costs, and strategies to address leaked care.

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“…Early pediatric ACOs have shown promise in increasing preventive services and reducing costs . However, designs have varied widely, with few published reports.…”

Section: Introductionmentioning

confidence: 99%

“…Early pediatric ACOs have shown promise in increasing preventive services and reducing costs. 14 , 15 , 16 , 17 , 18 However, designs have varied widely, with few published reports. Thus, it is difficult to identify components that influence pediatric ACO success.…”

Section: Introductionmentioning

confidence: 99%

Analysis of North Carolina Medicaid Claims Data to Simulate a Pediatric Accountable Care Organization

Cholera,

Anderson,

Chung

et al. 2023

JAMA Netw Open

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The Impact of Medicaid Accountable Care Organizations on Health Care Utilization, Quality Measures, Health Outcomes and Costs from 2012 to 2023: A Scoping Review

Holm,

Pagán,

Silver

2024

Med Care Res Rev

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Most of the evidence regarding the success of ACOs is from the Medicare program. This review evaluates the impacts of ACOs within the Medicaid population. We identified 32 relevant studies published between 2012 and 2023 which analyzed the association of Medicaid ACOs and health care utilization ( n = 21), quality measures ( n = 18), health outcomes ( n = 10), and cost reduction ( n = 3). The results of our review regarding the effectiveness of Medicaid ACOs are mixed. Significant improvements included increased primary care visits, reduced admissions, and reduced inpatient stays. Cost reductions were reported in a few studies, and savings were largely dependent on length of attribution and years elapsed after ACO implementation. Adopting the ACO model for the Medicaid population brings some different challenges from those with the Medicare population, which may limit its success, particularly given differences in state Medicaid programs.

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Promoting Child Health Equity Through Medicaid Innovation

Peltz¹,

Wong²,

Garg³

2022

Pediatr Ann

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Black, Latino/a/e, American Indian, and Alaska Native children often receive lower quality health care than White children. As the predominant health insurer for medically underserved populations, Medicaid plays a critical role in advancing socioeconomic and racial health equity. In this article, we focus on structural barriers to health equity in the Medicaid program and potential steps for improving long-standing socioeconomic and racial health inequities through programmatic innovation. We identify opportunities for expanding care models for holistically addressing the social determinants of health, aligning clinical care delivery around health equity principles, diversifying the clinical workforce, and promoting meaningful and consistent provider participation in Medicaid. Practitioners and policy makers can start to undertake many of these steps today to set the stage for more sweeping reforms that can help achieve national health equity goals for children. [ Pediatr Ann . 2022;51(3):e118–e122.]

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Coordinated Care Organizations and mortality among low‐income infants in Oregon

Cited by 3 publications

References 31 publications

Analysis of North Carolina Medicaid Claims Data to Simulate a Pediatric Accountable Care Organization

Analysis of North Carolina Medicaid Claims Data to Simulate a Pediatric Accountable Care Organization

The Impact of Medicaid Accountable Care Organizations on Health Care Utilization, Quality Measures, Health Outcomes and Costs from 2012 to 2023: A Scoping Review

Promoting Child Health Equity Through Medicaid Innovation

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