Advertisement

Maternal and Child Health Journal

, Volume 18, Issue 1, pp 38–44 | Cite as

Effect of an Integrated Care System on Utilization for CSHCN in Florida

  • Mircea I. Marcu
  • Caprice A. KnappEmail author
  • Vanessa L. Madden
  • Hua Wang
  • Meggen Kaufmann
  • Phyllis Sloyer
Article
  • 345 Downloads

Abstract

In 2006, Florida began a pilot program under a federal Medicaid waiver to reform its Medicaid program in Broward and Duval counties. The Children’s Medical Services Network, a subcontracted health care delivery system for Florida’s children with special health care needs (CSHCN) enrolled in public insurance programs, participated in Medicaid reform through an Integrated Care System (ICS) for its enrollees. The ICS constitutes a significant departure from the subcontracted fee-for-service system used to deliver care to CSHCN in the non-reform counties, and limited information exists about its impact. The purpose of this study was to assess the effects of the ICS on Medicaid utilization among CSHCN in Broward and Duval. Administrative data from 3,947 CSHCN in Broward and Duval, and two control counties, enrolled in Florida’s Medicaid program between 2006 and 2008 were used for analyses. Fixed effects negative binomial models were used to estimate the impact of the ICS on inpatient, outpatient, and emergency department utilization. Results show the number of outpatient visits decreased by 9 % in Broward and 16 % in Duval. The number of inpatient stays decreased in Duval by 35 %. Emergency room utilization increased slightly in Broward, although the estimate was not significant. Results suggest that managed care under the ICS has impacted utilization, most significantly for inpatient care. The ICS presents a viable model of managed care for CSHCN that could result in cost savings. Results should be interpreted with care because the full effects of the ICS implementation may take more time to materialize.

Keywords

Children Medicaid Managed care Integrated care Health care cost Health econometrics Count data models 

References

  1. 1.
    McPherson, M., Arango, P., & Fox, H. (1998). A new definition of children with special health care needs. Pediatrics, 102, 137–140.CrossRefGoogle Scholar
  2. 2.
    Centers for Disease Control and Prevention [Internet]. National Survey of Children with Special Health Care Needs, 2009–2010. 2012 [cited 2013 Jan 31]. Available from: http://childhealthdata.org/learn/NS-CSHCN.
  3. 3.
    Sloyer, P., Handler, E., & Brooks, R. (2000). Florida Department of Health. The Children’s Medical Services Network: Florida’s public/private managed care approach for children with special health care needs. Florida Health Care Journal, 103, 35–41.Google Scholar
  4. 4.
    Inkelas, M. (2005). Incentives in a Medicaid carve-out: Impact on children with special health care needs. Health Services Research, 40(1), 79–100.CrossRefGoogle Scholar
  5. 5.
    Mitchell, J., Gaskin, D., & Kozma, C. (2008). Health supervision visits among SSI-eligible children in the D.C. Medicaid program: A comparison of enrollees in fee-for-service and partially capitated managed care. Inquiry, 45(2), 198–214.CrossRefGoogle Scholar
  6. 6.
    Schuster, C., Mitchell, J., & Gaskin, D. (2007). Partially capitated managed care versus FFS for special needs children. Health Care Financing Review, 28(4), 109–123.PubMedPubMedCentralGoogle Scholar
  7. 7.
    Mitchell, J., & Gaskin, D. (2004). Do children receiving Supplemental Security Income who are enrolled in Medicaid fare better under a fee-for-service or comprehensive capitation model? Pediatrics, 114(1), 196–204.CrossRefGoogle Scholar
  8. 8.
    Huffman, L., Brat, G., Chamberlain, L., & Wise, P. (2010). Impact of managed care on publicly insured children with special health care needs. Academic Pediatrics, 10(1), 48–55.CrossRefGoogle Scholar
  9. 9.
    Puhani P. The treatment effect, the cross difference, and the interaction term in nonlinear “difference-in-differences” models. 2008. IZA Discussion Paper No.: 3478.Google Scholar
  10. 10.
    Setterobulte, W., & Kolip, P. (1997). Gender-specific factors in the utilization of medical services during adolescence. Journal of Adolescence, 20, 121–132.CrossRefGoogle Scholar
  11. 11.
    Hoover, K., Tao, G., Berman, S., & Kent, C. (2010). Utilization of services in physician offices and outpatient clinics by adolescents and young women in the United States: Implications for improving access to reproductive health services. Journal of Adolescent Health, 46(4), 324–330.CrossRefGoogle Scholar
  12. 12.
    Ziv, A., Boulet, J., & Slap, G. (1999). Utilization of physician offices by adolescents in the United States. Pediatrics, 104(1), 35–42.CrossRefGoogle Scholar
  13. 13.
    Sweeting, H. (1995). Reversals of fortune? Sex differences in health in childhood and adolescence. Social Science and Medicine, 40, 77–90.CrossRefGoogle Scholar
  14. 14.
    Neff, J., Sharp, V., Muldoon, J., Graham, J., & Myers, K. (2004). Profile of medical charges for children by health status group and severity level in a Washington state health plan. Health Services Research, 39(1), 73–89.CrossRefGoogle Scholar
  15. 15.
    StataCorp. Statistical analysis software for professionals: Release 9. 2005 (cited 2008 Jul 15). Available from: http://www.stata.com/products/overview.html.
  16. 16.
    Kaiser Family Foundation (Internet). State health facts, hospital adjusted expenses per inpatient day, 2010. 2012 (cited 2013 Jan 31). Available from: http://www.statehealthfacts.org/comparemaptable.jsp?ind=273&cat=5.
  17. 17.
    Knapp, C., Madden, V., Sloyer, P., Shenkman, E. (2012). Effects of an integrated care system on satisfaction and quality of care for children with special health care needs. Maternal and Child Health Journal, 16(3), 579–586.CrossRefGoogle Scholar
  18. 18.
    Institute for Healthcare Improvement (Internet). IHI Triple Aim Initiative. 2012 (cited 2013 Jan 31). Available from: http://www.ihi.org/offerings/Initiatives/TripleAim/Pages/default.aspx.

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Mircea I. Marcu
    • 1
  • Caprice A. Knapp
    • 1
    Email author
  • Vanessa L. Madden
    • 1
  • Hua Wang
    • 1
  • Meggen Kaufmann
    • 1
  • Phyllis Sloyer
    • 2
  1. 1.Department of Health Outcomes and Policy, Institute for Child Health PolicyUniversity of FloridaGainesvilleUSA
  2. 2.Children’s Medical Services DivisionFlorida Department of HealthTallahasseeUSA

Personalised recommendations