Continuity of care among seniors and persons with disabilities (SPDs) and subsequent emergency department and inpatient utilization after transition to managed care

Background: As part of its “Bridge to Healthcare Reform”, California began transitioning “Seniors and Persons with Disabilities” (SPDs) with fee-for-service Medicaid coverage into a managed care plan in June 2011. A total of 17,488 SPDs were assigned to LACDHS (a large urban safety net health system) and made visits to LACDHS during the year after the mandate; 14,841 had utilized LACDHS in the two years prior (long-term), while the remaining 2,647 only utilized LACDHS services after the mandate (short-term). Methods: Encounter data (163,708 encounters) were analyzed for the 17,488 SPDs with visits between June 2011 and May 2012. The association between their types of visits (outpatient, ED or inpatient) and their status (long-term vs. short-term) were assessed using logistic regression. Results: In an age-adjusted model, short-term utilizers had a significantly higher percentage of ED visits (by 69%; OR=1.69, 95%CI 1.58 – 1.80), higher percentage of inpatient hospitalizations (by 2-fold; OR=1.97, 95%CI 1.81 – 2.15), as well as longer average length of inpatient stay (9.8 days vs. 6.5 days; p< 0.0001) compared to those who were long-term SPD LACDHS utilizers. This was despite the fact that short-term utilizers had a significantly higher percentage of primary care visits (short-term (27.9%) vs. long-term (24.4%); p<0.0001). Conclusion: These findings suggest that SPDs who were long-term LACDHS patients had significantly fewer ED visits and inpatient admissions, and shorter length of inpatient stays. This may indicate that among SPD patients, continuity of health care in a safety net system can subsequently reduce ED visits and hospitalizations.