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Health Serv Res. 2019 Oct;54(5):1007-1015. doi: 10.1111/1475-6773.13199. Epub 2019 Aug 6.

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

Author information

1
Department of Health Policy and Management, The Gillings School of Global Public Health, and The Cecil G. Sheps Center for Health service Research, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
2
Division of Health Service Management and Policy, College of Public Health, Division of General Internal Medicine, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio.
3
Department of Pediatrics, Center for Innovation in Pediatric Practice, The Research Institute at Nationwide Children's Hospital, The Ohio State University, Columbus, Ohio.
4
Columbus Public Health, Columbus, Ohio.
5
Carolina Cancer Screening Initiative, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Carrboro, North Carolina.
6
Management & Organizations, Eller College of Management, The University of Arizona, Tucson, Arizona.

Abstract

OBJECTIVE:

To examine the impact of a Medicaid-serving pediatric accountable care organization (ACO) on health service use by children who qualify for Medicaid by virtue of a disability under the "aged, blind, and disabled" (ABD) eligibility criteria.

DATA SOURCES/STUDY SETTING:

We evaluated a 2013 Ohio policy change that effectively moved ABD Medicaid children into an ACO model of care using Ohio Medicaid administrative claims data for years 2011-2016.

STUDY DESIGN:

We used a difference-in-difference design to examine changes in patterns of health care service use by ABD-enrolled children before and after enrolling in an ACO compared with ABD-enrolled children enrolled in non-ACO managed care plans.

DATA COLLECTION/EXTRACTION METHODS:

We identified 17 356 children who resided in 34 of 88 counties as the ACO "intervention" group and 47 026 ABD-enrolled children who resided outside of the ACO region as non-ACO controls.

PRINCIPAL FINDINGS:

Being part of the ACO increased adolescent preventative service and decreased use of ADHD medications as compared to similar children in non-ACO capitated managed care plans. Relative home health service use decreased for children in the ACO.

CONCLUSIONS:

Our overall results indicate that being part of an ACO may improve quality in certain areas, such as adolescent well-child visits, though there may be room for improvement in other areas considered important by patients and their families such as home health service.

KEYWORDS:

alternative payment models; children with disabilities; medicaid accountable care organizations; pediatric accountable care organizations; value-based payment

PMID:
31388994
DOI:
10.1111/1475-6773.13199

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