295 - The Effects of Medicaid Financing and Delivery System Reform on Children with Asthma

Poster Number: 295
Publication Number: 295.1503

Background: More than six million children in the U.S. have asthma and more than half have poorly controlled disease. A growing number of children are enrolled in Medicaid Accountable Care Organizations (ACO), which are value-based payment models that hold groups of healthcare providers and payers responsible for total costs and quality of care for a defined patient population. Despite the increasing use of Medicaid ACOs , little is known about their impact on care for children with asthma.

Objective: To determine associations between Medicaid ACO implementation in Massachusetts on utilization-based outcomes for children with asthma.

Design/Methods: Using the Massachusetts All Payer Claims Database, we identified privately and publicly insured children with asthma. We use a difference-in-difference design to compare outcomes pre- and post- Medicaid ACO implementation among Medicaid insured children with asthma (first difference) to privately insured children with asthma in the same year (second difference). The primary outcomes were binary measures of any acute care use with an asthma diagnosis (i.e., emergency department, hospitalization, or hospital observation), and any routine asthma visit (i.e., well-child visit with an asthma diagnosis code or outpatient visit with asthma diagnosis on the same day as a well-child visit).
Regression models estimated differences in outcomes accounting for child and area characteristics including demographics, health status, persistent asthma, calendar year, and 5-digit ZIP code characteristics.

Results: Among 382,354 child-year observations, 62.3% were Medicaid-insured and 19.2% had persistent asthma. Across the period, rates of asthma related acute care use were higher among children with Medicaid as compared to those with private insurance (29.6% vs 15.9%), while rates of routine asthma visits were lower among Medicaid-insured than privately-insured children (66.1% vs 75.1%). Regression adjusted results showed that among children with asthma, implementation of Medicaid ACOs was associated with a 18% increase in the odds of acute care use (95% CI: 1.12, 1.24) and a 10% reduction in the odds of routine asthma visit use (95% CI: 0.86,0.95) for Medicaid insured children.

Conclusion(s): Contrary to expectations, implementation of Medicaid ACOs in Massachusetts was associated with an increase in acute care use and no change in routine asthma visit use. These findings highlight ongoing disparities in health outcomes for low-income children and suggest that improving access to routine care may be one approach to improving health equity.