142nd APHA Annual Meeting and Exposition

Annual Meeting Recordings are now available for purchase

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

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Wednesday, November 19, 2014 : 8:30 AM - 8:45 AM

Tenaya Sunbury, PhD , Strategic Decision Support, Texas Health and Human Services Commission, Austin, TX
Sarah Roper-Coleman, MA , Strategic Decision Support, Texas Health and Human Services Commission, Austin, TX
Angela Cummings, DrPH , Strategic Decision Support, Texas Health and Human Services Commission, Austin, TX
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).

Learning Areas:

Chronic disease management and prevention
Conduct evaluation related to programs, research, and other areas of practice
Program planning

Learning Objectives:
Discuss Medicaid managed care models and program activities in Texas. Describe the strengths and limitations of quality of care measures to aged and disabled population. List lessons and recommendations for large-scale program evaluations.

Keyword(s): Managed Care, Evaluation

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Dr. Sunbury designs and conducts evaluations on public health programs. She is currently working for the Texas Health and Human Services Commission as a program evaluator on the 1115(a) Texas Healthcare Transformation and Quality Improvement Program.
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.