Examining the impact of Medicaid-managed care home-based and community-based service (HCBS) alternatives to institutional care is critical given the recent rapid expansion of these models nationally.
We analyzed the effects of STAR+PLUS, a Texas Medicaid-managed care HCBS waiver program for adults with disabilities on the quality of chronic disease care.
We compared quality before and after a mandatory transition of disabled Medicaid enrollees older than 21 years from fee-for-service (FFS) or primary care case management (PCCM) to STAR+PLUS in 28 counties, relative to enrollees in counties remaining in the FFS or PCCM models.
Person-level claims and encounter data for 2006–2010 were used to compute adherence to 6 quality measures. With county as the independent sampling unit, we employed a longitudinal linear mixed-model analysis accounting for administrative clustering and geographic and individual factors.
Although quality was similar among programs at baseline, STAR+PLUS enrollees experienced large and sustained improvements in use of β-blockers after discharge for heart attack (49% vs. 81% adherence posttransition; P<0.01) and appropriate use of systemic corticosteroids and bronchodilators after a chronic obstructive pulmonary disease event (39% vs. 68% adherence posttransition; P<0.0001) compared with FFS/PCCM enrollees. No statistically significant effects were identified for quality measures for asthma, diabetes, or cardiovascular disease.
In 1 large Medicaid-managed care HCBS program, the quality of chronic disease care linked to acute events improved while that provided during routine encounters appeared unaffected.
Departments of *Health Outcomes and Policy
†Epidemiology, University of Florida, Gainesville, FL
‡Aetna Foundation, Hartford, CT
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Present address: Matthew F. Van Voorhis, PhD, Consumer Reports, Yonkers, NY.
Supported in part by the NIH/NCATS Clinical and Translational Science Awards to the University of Florida TL1 TR000066 and UL1 TR000064.
The authors declare no conflict of interest.
Reprints: Elizabeth A. Shenkman, PhD, Department of Health Outcomes and Policy, University of Florida, 2004 Mowry Road, Gainesville, FL 32610. E-mail: email@example.com.