Dataset Information

Pediatric outpatient utilization by differing Medicaid payment models in the United States.

ABSTRACT:

Background

In the United States (US), Medicaid capitated managed care costs are controlled by optimizing patients' healthcare utilization. Adults in capitated plans utilize primary care providers (PCP) more than emergency departments (ED), compared to fee-for-service (FFS). Pediatric data are lacking. We aim to determine the association between US capitated and FFS Medicaid payment models and children's outpatient utilization.

Methods

This retrospective cohort compared outpatient utilization between two payment models of US Medicaid enrollees aged 1-18?years using Truven's 2014 Marketscan Medicaid database. Children enrolled >?11?months were included, and were excluded for eligibility due to disability/complex chronic condition, lack of outpatient utilization, or provider capitation penetration rate??95%. Negative binomial and logistic regression assessed relationships between payment model and number of visits or odds of utilization, respectively.

Results

Of 711,008 children, 66,980(9.4%) had FFS and 644,028(90.6%) had capitated plans. Children in capitated plans had greater odds of visits to urgent care, PCP-acute, and PCP-well-child care (aOR 1.21[95%CI 1.15-1.26]; aOR 2.07[95%CI 2.03-2.13]; aOR 1.86 [95%CI 1.82-1.91], respectively), and had lower odds of visits to EDs and specialty care (aOR 0.82 [95%CI 0.8-0.83]; aOR 0.61 [95%CI 0.59-0.62], respectively), compared to FFS.

Conclusions

The majority of children in this US Medicaid population had capitated plans associated with higher utilization of acute care, but increased proportion of lower-cost sites, such as PCP-acute visits and UC. Health insurance programs that encourage capitated payment models and care through the PCP may improve access to timely acute care in lower-cost settings for children with non-complex chronic conditions.

SUBMITTER: Canares TL

PROVIDER: S-EPMC7291721 | biostudies-literature | 2020 Jun

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Pediatric outpatient utilization by differing Medicaid payment models in the United States.

Canares Therese L TL Friedman Ari A Rodean Jonathan J Burns Rebecca R RR Berkowitz Deena D Hall Matt M Alpern Elizabeth E Montalbano Amanda A

BMC health services research 20200612 1

<h4>Background</h4>In the United States (US), Medicaid capitated managed care costs are controlled by optimizing patients' healthcare utilization. Adults in capitated plans utilize primary care providers (PCP) more than emergency departments (ED), compared to fee-for-service (FFS). Pediatric data are lacking. We aim to determine the association between US capitated and FFS Medicaid payment models and children's outpatient utilization.<h4>Methods</h4>This retrospective cohort compared outpatient ...[more]

PMID: 32532270

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Dataset Information

Pediatric outpatient utilization by differing Medicaid payment models in the United States.

Background

Methods

Results

Conclusions

Publications

Pediatric outpatient utilization by differing Medicaid payment models in the United States.

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