Evaluation of the Effects of a Complex Care Management Program on Health-Related Quality of Life within a Medicaid Population

Objective: Complex Care Management (CCM) Programs are often used to identify need and service linkage for medical and non-medical services among the Medicaid population. Little is known, however, regarding the impact of CCM Programs on health-related quality of life (HRQL) in Medicaid populations. The aims of this study are: 1) to compare HRQL scores in a Medicaid population enrolled in CCM to national norms by age and gender and 2) to assess the effects of CCM on maintaining or improving HRQL over time.

Study Design: We identified 255 patients enrolled in a Medicaid Health Plan located in the Pacific Northwest that received CCM services. To assess HRQL, the Health Utilities Mark 3 (HUI3) was administered at baseline and at follow-up (4-5.5. months later). HUI3 includes 8 attributes (vision, hearing, speech, ambulation, dexterity, emotion, cognition, pain) with 5 or 6 levels per attribute. Overall HUI3 scores are on a scale in which dead = 0 and perfect health = 1. Differences/changes of 0.03 or more in overall HUI3 scores are regarded as clinically important. Appropriate bivariate statistics were used to compare mean HUI3 scores at baseline and follow-up.

Results: Overall, mean baseline HUI3 scores were 0.19 (SD=0.30), substantially lower than the norm for the US adult population using the age and gender distribution observed in the Medicaid cohort (mean=0.81). Nearly 80% of all respondents reported moderate or severe pain at baseline. Mean HUI3 scores over 4+ months improved from baseline by 0.04 (SD=0.27). Differences between baseline and the 4 month follow-up, however, were not statistically significant, although the 0.04 improvement in overall HUI3 scores is considered to be clinically important.

Conclusions: Overall, we found HRQL to be very low in the observed Medicaid population relative to US norms. We found clinically meaningful improvement in HUI3 scores over time among patients enrolled in a CCM program. Because CCM enrollees were only followed for 4 months, more work is needed to understand better the long-term effects of CCM exposure on HRQL. Such information can be used to design more effective programs to improve and enhance CCM Programs for Medicaid recipients.