Evaluating Medicaid coordinated care in Colorado

Health care costs in the U.S. are concentrated in several groups of high-needs health care users, including individuals with multiple chronic conditions. To improve the quality of care for such groups while reducing costs, health care systems have begun turning to coordinated care, but there is little rigorous evidence about their effects, especially for non-elderly individuals with multiple chronic conditions. This study fills the gap in knowledge by evaluating two pilot coordinated care programs for blind and disabled Medicaid recipients in the Denver area.

From April through December 2009, more than 6,000 individuals were randomized in six Denver-area Counties. Of this group, 70 percent were assigned to the treatment group and passively enrolled in a managed care program run by either Colorado Access or Kaiser Permanente, while 30 percent were assigned to the control group. Care coordinators for the two managed care programs then attempted to enroll treatment group members in coordinated care. Coordinated care activities in these programs include managing the transition from hospital to home, monitoring the use of prescription medications, coordinating care plans through primary care physicians, and providing access to other social services such as transportation. The goal of the programs are to increase the use of primary and preventive care and reduce hospital admissions and Emergency Department use. Individuals were eligible for the program if they were blind or disabled and in the Colorado fee-for-service Medicaid system. At the time of random assignment, the sample was about 45 years old on average. The average person used $11,000 in health care services and was diagnosed with 2.5 chronic conditions in the year prior to random assignment. Care managers' initial assessments indicate that 70 percent of participants have a chronic condition such as diabetes or congestive heart failure that might benefit from care management. Of the highest needs group, 60 percent have received care management services delivered primarily by telephone or in high-volume clinics. In particular, 70 percent of patients who have been hospitalized have received help managing their transition to home.

The presentation at APHA will describe early estimates of the effects of the pilot programs on health care use, including primary and preventive care, hospital admissions, and Emergency Department use.