TY - JOUR
KW - accountable care organization
KW - Integrated care models
KW - marginal structural models
KW - Medicaid expansion
KW - Social Determinants of Health
AU - K. D. Vickery
AU - N. D. Shippee
AU - J. Menk
AU - R. Owen
AU - D. M. Vock
AU - P. Bodurtha
AU - D. Soderlund
AU - R. A. Hayward
AU - M. M. Davis
AU - J. Connett
AU - M. Linzer
A1 - 
AB - Hennepin Health, a Medicaid accountable care organization, began serving early expansion enrollees (very low-income childless adults) in 2012. It uses an integrated care model to address social and behavioral needs. We compared health care utilization in Hennepin Health with other Medicaid managed care in the same area from 2012 to 2014, controlling for demographics, chronic conditions, and enrollment patterns. Homelessness and substance use were higher in Hennepin Health. Overall adjusted results showed Hennepin Health had 52% more emergency department visits and 11% more primary care visits than comparators. Over time, modeling a 6-month exposure to Hennepin Health, emergency department and primary care visits decreased and dental visits increased; hospitalizations decreased nonsignificantly but increased among comparators. Subgroup analysis of high utilizers showed lower hospitalizations in Hennepin Health. Integrated, accountable care under Medicaid expansion showed some desirable trends and subgroup benefits, but overall did not reduce acute health care utilization versus other managed care.
BT - Medical care research and review : MCRR
C5 - Healthcare Disparities; Healthcare Policy
CY - United States
DO - 10.1177/1077558718769481
JF - Medical care research and review : MCRR
N2 - Hennepin Health, a Medicaid accountable care organization, began serving early expansion enrollees (very low-income childless adults) in 2012. It uses an integrated care model to address social and behavioral needs. We compared health care utilization in Hennepin Health with other Medicaid managed care in the same area from 2012 to 2014, controlling for demographics, chronic conditions, and enrollment patterns. Homelessness and substance use were higher in Hennepin Health. Overall adjusted results showed Hennepin Health had 52% more emergency department visits and 11% more primary care visits than comparators. Over time, modeling a 6-month exposure to Hennepin Health, emergency department and primary care visits decreased and dental visits increased; hospitalizations decreased nonsignificantly but increased among comparators. Subgroup analysis of high utilizers showed lower hospitalizations in Hennepin Health. Integrated, accountable care under Medicaid expansion showed some desirable trends and subgroup benefits, but overall did not reduce acute health care utilization versus other managed care.
PP - United States
PY - 2018
SN - 1552-6801; 1077-5587
SP - 1077558718769481
T1 - Integrated, Accountable Care For Medicaid Expansion Enrollees: A Comparative Evaluation of Hennepin Health
T2 - Medical care research and review : MCRR
TI - Integrated, Accountable Care For Medicaid Expansion Enrollees: A Comparative Evaluation of Hennepin Health
U1 - Healthcare Disparities; Healthcare Policy
U2 - 29749302
U3 - 10.1177/1077558718769481
VO - 1552-6801; 1077-5587
Y1 - 2018
ER -