Texas Healthcare Transformation and Quality Improvement Program: Impacts of Medicaid policy change on quality of care for aged and disabled population

BACKGROUND: The goal of Texas’ STAR+PLUS program is to integrate acute and long-term services into a Medicaid managed care delivery system for Supplemental Security Income (SSI) and SSI-related clients. Effective December 2011, Centers for Medicare and Medicaid Services (CMS) approved a five-year 1115(a) waiver to expand STAR+PLUS from four service delivery areas (SDAs) to seven SDAs. The program evaluation investigates the impact on the quality of care pre- and post- policy change. OBJECTIVE: To obtain baseline results (years 2008-2011) about clients who received STAR+PLUS benefits for the purposes of identifying and categorizing quality of care Healthcare Effectiveness Data and Information Set (HEDIS®) measures by region and managed care organization (MCO). METHODS: Nine quality of care indicators prior to expansion were obtained from 1) member-level enrollment information, 2) member-level health care claims/encounter data, and 3) member-level pharmacy data. Rates were calculated using the number of admissions per 100,000 eligible members or admissions. RESULTS: From 2008-2011, STAR+PLUS enrollment increased 76% from 78,245 to 137,372 clients.  New counties accounted for 37% of enrollment increase. Compared to 2008, baseline counties exhibited lowered hospital admission rates for: diabetes short-term complications, hypertension (except Travis SDA), congestive heart failure (except Nueces SDA), dehydration (except Harris & Nueces SDAs), bacterial pneumonia, urinary tract infection, uncontrolled diabetes (except Nueces SDA), and lower-extremity amputations among diabetes patients. There was no change in diabetes long-term complications for any SDA. When available, hospital admission rates for most conditions exceeded national estimates reported by the Agency for Healthcare Research and Quality (AHRQ).