Online Program

Medicaid managed care impacts on quality of care and readmissions for high risk diabetic children

Monday, November 4, 2013 : 10:50 a.m. - 11:10 a.m.

Kathleen Healy-Collier, DHA, Medical University of South Carolina, Regional Medical Center, Cordova, TN
Walter Jones, PhD, Department of Healthcare Leadership and Management, Medical University of South Carolina, Charleston, SC
Jim Schmerling, DHA, Children's Hospital Colorado, Aurora, CO
Kenneth Robertson, MD, MBA, LeBonheur Children's Hospital, Memphis, TN
Robert Ferry, MD, Division of Pediatric Endocrinology, Univerisity of Tennessee and Le Bonheur Children's Hospital, Memphis, TN
Background: As many as three million individuals had Type I diabetes in the United States in 2011. With Medicaid program variations, there are potentially large differences in access and quality of care for child diabetics. However, no previous studies have holistically assessed the impact of Medicaid managed care on juvenile diabetic treatment. Methods: This study used a retrospective four year cross-sectional design with Children's Hospital Association PHIS data from 43 hospitals in 26 states, including 4,762 patients with 12,104 qualifying admissions, to determine whether juvenile onset diabetic patients are more or less likely to be readmitted with uncontrolled diabetes if they are on a Medicaid managed care plan. Multiple factors for readmission were analyzed including age, race, gender, severity of illness (APR-DRG), patient type on discharge, and state. Results: Simple readmission rates by state ranged from 4.08% to 24.82 %. The relationship between state and days between readmissions was significant (P<.0001). Logistic regression revealed that overall readmission was more likely for Medicaid patients on non-managed care plans than for those on managed care (Chi-Square 4.3, P = 0.0373), and that those on non-managed care plans were 1.12 times more likely to be readmitted. Conclusions: Primary care and public health organizations need to examine their state's Medicaid care structure and consider whether or not it is engaging in “best practices” for pediatric diabetic patients, so as to provide the best possible framework for effective service delivery. Other states may provide viable models for emulation for those states not effectively managing care.

Learning Areas:

Conduct evaluation related to programs, research, and other areas of practice
Provision of health care to the public
Public health administration or related administration
Public health or related public policy

Learning Objectives:
Describe the impacts of Medicaid managed care on health outcomes for high risk diabetic children. Identify possible ways in which public health professionals dealing with high risk diabetic children (particularly those on Medicaid) can provide better care management

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the primary researcher on the project which is the subject of the presentation, including data collection, analysis and report writing.
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.