How does being part of a pediatric accountable care organization impact health service use for children with disabilities?

Song, Paula H.; Xu, Wendy; Chisolm, Deena J.; Alexy, Emily; Ferrari, Renée M.; Hilligoss, Brian; Domino, Marisa Elena

doi:10.1111/1475-6773.13199

Cited by 9 publications

(10 citation statements)

References 13 publications

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“…10,11 More work needs to be done to understand the implications of these changes on pediatric services. Song et al 12 found decreases in home health use when comparing Medicaid Managed Care enrolled patients to Medicaid fee-for-service patients in the ABD population.…”

Section: Discussionmentioning

confidence: 99%

“…More work needs to be done to understand the implications of these changes on pediatric services. Song et al 12 found decreases in home health use when comparing Medicaid Managed Care enrolled patients to Medicaid fee‐for‐service patients in the ABD population. They reported a 4‐percentage‐point decrease in access to home health care service after transition into Medicaid Managed Care.…”

Section: Discussionmentioning

confidence: 99%

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Left behind again: Rural home health services in a Medicaid pediatric accountable care organization

Hardy

Liu

Conkol³

et al. 2021

The Journal of Rural Health

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Purpose To contrast trends in rural and urban pediatric home health care use among Medicaid enrollees. Methods Medicaid administrative claims data were used to assess differences in home health care use for child members in a large pediatric accountable care organization (ACO) in Ohio. Descriptive statistics assessed rural and urban differences in health care use over a 10‐year period between 2010 and 2019. Findings Pediatric home health care use increased markedly in the low‐income (CFC) and disabled (ABD) Medicaid categories. Over the past 10 years, CFC‐enrolled children from urban communities have seen more home health visits, fewer emergency department (ED) visits, and more well child visits compared to rural CFC‐enrolled children. Children enrolled due to disabilities in urban communities have also seen more home health visit use but fewer preventive care visits than their rural counterparts. Conclusions Within a pediatric ACO, rural home health care use has remained relatively stagnant over a 10‐year period, a stark contrast to increases in home health care use among comparable urban populations. There are likely multiple explanations for these differences, including overuse in urban communities, lack of access in rural communities, and changes to home health reimbursement. More can be done to improve rural home health access. Such improvement will likely necessitate large‐scale changes to home health care delivery, workforce, and financing. Improvements should be evaluated for return‐on‐investment not only in terms of direct costs, that is, reduced inpatient or ED costs, but also in terms of patient and family quality‐of‐life or key indicators of child well‐being such as educational attainment.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Left behind again: Rural home health services in a Medicaid pediatric accountable care organization

Hardy

Liu

Conkol³

et al. 2021

The Journal of Rural Health

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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%

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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“…In recent years, the prevalence of childhood obesity has raised concerns because of the possible clinical and public health consequences ( 35 ). Childhood obesity leads to an increased risk of chronic diseases and seriously affects children's health ( 36 ). Previous studies find many factors affecting childhood obesity.…”

Section: Introductionmentioning

confidence: 99%

Grandchild care, inadequate medical insurance protection, and inequalities in socioeconomic factors exacerbate childhood obesity in China

Yang

Shen

Deng

et al. 2022

Front. Public Health

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This study examines the influences of grandchild care and medical insurance on childhood obesity. Nationally representative longitudinal data—from the China Family Panel Studies 2010–2020—of 26,902 school-age children and adolescents aged 6–16 years and China's new reference standard (“WS/T586-2018”) are used to identify a child's obesity status. Using binary mixed-effects logistic regression models and the Blinder–Oaxaca decomposition method, this study explores the roots of obesity inequalities and finds that at least 15% of Chinese children aged 6–16 were obese in the 2010s. The logistic regression analysis results indicate that grandchild care, public medical insurance, and commercial medical insurance are key risk factors of child obesity. However, the influences are heterogeneous in different groups: Grandchild care and public medical insurance increase urban–rural obesity inequalities because of a distribution effect, and grandchild care may also exacerbate children obesity inequalities between left-behind and non-left-behind children owing to the event shock of parental absence. Inequalities in socioeconomic status (SES) factors such as income, education, and region also cause obesity inequalities. These results indicate that child obesity and its inequalities are rooted in multidimensional environmental inequalities, including medical protection policies and its benefit incidence; intergenerational behavior and family SES factors; and urban–rural and left-behind risk shocks. This study provides new evidence for the development of population-based interventions and equitable medical insurance policies to prevent the deterioration of child obesity among Chinese school-age children and adolescents.

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How does being part of a pediatric accountable care organization impact health service use for children with disabilities?

Cited by 9 publications

References 13 publications

Left behind again: Rural home health services in a Medicaid pediatric accountable care organization

Left behind again: Rural home health services in a Medicaid pediatric accountable care organization

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

Grandchild care, inadequate medical insurance protection, and inequalities in socioeconomic factors exacerbate childhood obesity in China

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