Retrospective analysis of healthcare utilization and expenditures associated with an integrated, care coordination model serving Medicaid-eligible children with medical complexities




Marshall, Landon Zane

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Objectives: From a payer perspective, examine the effects of a pediatrician-led care coordination model (PLCM) versus usual, standard pediatric care (SPC) on health utilization and expenditure patterns in a randomized cohort of Medicaid-eligible children with medical complexities (CMC). Methods: Retrospective secondary database analysis of Texas Medicaid administrative medical and prescription claims data of 222 patients previously enrolled in the Specially for Children pilot study from January 1, 2010 to October 31, 2015. Medical diagnoses for 222 patients from inpatient and outpatient claims data were utilized to determine clinical complexity status while bivariate and generalized linear models provided two-year unadjusted and adjusted utilization and expenditures measures. Linear-mixed effects regression models were used to model individual growth curves in medical and outpatient prescription expenditures. Results: A total of 212 patients (95.5%) were identified as having complex chronic medical conditions. Two-year expenditures averaged $217,812 per patient across the study cohort with outpatient medical services accounting for the largest proportion of total healthcare expenditures (64.6%). The inclusion of model covariates resulted in average two-year expenditures of $124,026 in the PLCM and $112,911 in SPC (difference- $11,115 [95% CI -$15,280 to $44,648]). Variability in medical and prescription expenditures were largely due to between-person differences. Rates of change in medical and prescription expenditures were not significantly different from zero. Conclusion: Population-based identification methods exhibited a high level of agreement with prospective, clinician determined classification of children with complex chronic conditions. Total healthcare expenditures and rates of change were not significantly different between the two study groups while significant variability existed between patients. These findings demonstrate similar expenditures among a largely neuro-impaired cohort of CMC cared for under an enhanced care model despite high outpatient medical and prescription expenditure and concentrated spending among relatively few patients.


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