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Quality of Care for Chronic Conditions Among Disabled Medicaid Enrollees

An Evaluation of a 1915 (b) and (c) Waiver Program

Wegman, Martin P. BS*,†; Herndon, Jill B. PhD*; Muller, Keith E. PhD*; Graham, Garth N. MD, MPH; Vogel, W. Bruce PhD*; Case, Kimberly H. PhD*; Lee, Jason A. MSPH*; Van Voorhis, Matthew F. PhD*; Shenkman, Elizabeth A. PhD*

doi: 10.1097/MLR.0000000000000371
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Importance: 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.

Objective: 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.

Design, Setting, and Participants: 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.

Measures and Analysis: 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.

Results: 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.

Conclusion: 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

Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website, www.lww-medicalcare.com.

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: eshenkman@ufl.edu.

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.