266551 A cost saving evaluation of Ilinois Medicaid Patient Centered Medical Home program

Monday, October 29, 2012 : 11:06 AM - 11:18 AM

Robert Phillips, MD MPH , Robert Graham Center, American Academy of Family Physicians, Washington, DC
Meiying Han, PhD , Robert Graham Center, American Academy of Family Physicians, Washington, DC
Stephen Petterson, PhD , The Robert Graham Center for Policy Studies in Family Medicine and Primary Care, American Academy of Family Physicians, Washington, DC
Laura Makaroff, MD , Robert Graham Center, American Academy of Family Physicians, Washington, DC
Winston Liaw, MD MPH , Fairfax Family Practice, Fairfax, VA
In 2006, the state of Illinois implemented a primary care case management program (PCCM) called Illinois Health Connect (IHC) as an effort to reduce Medicaid spending and to move toward a Patient Centered Medical Home (PCMH) model. IHC now covers 70% of Illinois Medicaid patients (1.9 million enrollees).

This analysis utilizes Illinois Medicaid claims and enrollment data from Jan 1, 2004 to Dec 31, 2010. We found significant reductions in cost for all Medicaid cohorts. Illinois Medicaid overall costs in 2006 were $9.30 billion compared to $13.43 billion in 2010. The addition of nearly 1 million people to the Medicaid rolls over that period does not make the savings obvious, but based on 2006 costs, we estimate the total savings for 2007-2010 to be $531 million.

Medicaid hospitalization rates were already on the decline by 2006 compared to 2004, and continued to fall by nearly 20% between 2006 and 2010. Avoidable hospitalizations fell by almost 25% comparing 2010 to 2006. Over the same period, hospitalizations also realized efficiency improvements, as bed-days fell by 22.0%. Medicaid beneficiary ER visits rose between 2004 and 2006 but declined by 5.3% as of 2010.

A better understanding of cost and utilization will provide evidence for how Illinois and other states can best plan and pay for future healthcare delivery services. It will also inform medical home demonstrations underway in more than 40 states, most of which have not been fully evaluated.

Learning Areas:
Advocacy for health and health education
Biostatistics, economics
Planning of health education strategies, interventions, and programs
Program planning
Public health administration or related administration

Learning Objectives:
How effective is the Medicaid medical home program in reducing costs and inappropriate utilization between 2006 and 2010? How does the medical home program improve outcomes and delivery of appropriate preventive care between 2006 and 2010?

Keywords: Medicaid Managed Care, Cost Issues

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: As economist and health services researcher at the Robert Graham Center, I served as the primary analyst in a cost saving evaluation of Illinois Medicaid Patient Centered Medical Home program called Illinois Health Connect. The project is funded by the Commonwealth Fund with dataset support from Illinois Department of Healthcare and Family Services.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Back to: 3102.0: Medicare/Medicaid Policy