Integrated Care Reduces Hospital Stays for Medicaid Children

Children enrolled in Medicaid and exposed to an integrated care management program experienced a decrease of 0.39 monthly hospital admissions and 2.20 monthly bed-days per 1,000 children, compared to children who were not in the program, according to a recent study from researchers at the Perelman School of Medicine at the University of Pennsylvania.

The study of 25,460 children admitted to the hospital between January 1, 2014, and June 30, 2017, uncovered that targeted population health management intervention developed for children enrolled in Medicaid and receiving hospital care, is associated with a change in hospital admissions and bed days.

Nearly one-third of these admitted patients (33.1 percent) were from in-network practices. The rest of the children were considered out-of-network.

Additionally, children with medical complexity who received in-network care increased from 1131 children to 1632 children during the study period but experienced a monthly decrease in admissions of 0.54 per 1,000 beneficiaries compared to out-of-network patients.

These disparities could translate to a decrease of 3,600 bed-days for a population of 93,000 children eligible for Medicaid.

“Population health management strategy providing broad registry-based tools across a health system’s Medicaid-enrolled primary care population, alongside more precise integrated care team interventions for children with higher risk within the cohort, was associated with a large aggregate decrease in admissions and bed-days to the parent hospital,” researchers explained in the study.

Prior to the study, there were 93,365 children enrolled in Medicaid who were in-network, which increased by 32.1 percent during the study period, from 76,258 children to 100,767. The population of children who were considered out-of-network increased by 13.8 percent during the same period, from 198,548 to 225,989.

Patients were considered in-network if they had visited a physician or nurse practitioner in the health system’s primary care network during the previous two years. The comparison population were children who were enrolled in Medicaid but had not visited a primary care clinician for the same period of time. 

A shift in dependent health insurance coverage across the US is creating challenges for pediatric health systems to deliver efficient and cost-effective care, the study found.

Nearly 40 percent of children are currently covered by Medicaid, which now provides reimbursement for more than half of nonneonatal pediatric hospitalizations. Hospitalizations usually occur at lower reimbursement rates, which creates an issue for pediatric financial models, researchers highlighted.

Between 2004 and 2009, the number of hospital stays for those with medical complexities increased by 30 percent, compared to 10 percent among other children. As the Medicaid program has continued to grow in size, many health systems see increased pressure from payers to engage in risk contracting that requires value-based care for Medicaid recipients, the study uncovered.

“Population health management, imbued with interdisciplinary teams, quality improvement, and information technology, can help large pediatric health systems respond to the needs of an increasing, medically complex, Medicaid-enrolled population and mitigate capacity challenges by reducing inpatient hospitalization among the managed population,” researchers concluded.