Panel Paper: Evaluating a Novel Medicaid Medical Home Intervention for High-Risk Pregnant Women

Friday, November 7, 2014 : 8:50 AM
Fiesta 1 (Hyatt)

*Names in bold indicate Presenter

Lindsey Leininger1, Kristen Voskuil2 and Donna Friedsam2, (1)University of Illinois, Chicago, (2)University of Wisconsin Madison
The patient-centered medical home (PCMH) model – among the most prominent of the Affordable Care Act-era delivery system innovations – is currently receiving considerable policy and research attention. The goal of the PCMH is to provide high-quality, comprehensive care that is well-coordinated across provider types and service locations. Psychosocial issues often present significant barriers in safety net providers’ ability to attain this goal; accordingly, Medicaid agencies are exploring ways of incorporating psychosocial supports into pilot PCMH interventions. This paper provides an evaluation of an intervention adopting such an approach, placing it among a very few to explore the effectiveness of a Medicaid PCMH intervention focused on social support provision. Specifically, this paper estimates the effect of a Medicaid PCMH intervention targeting high-risk pregnant women in Southeast Wisconsin (Milwaukee area) during the years 2011-2013. The intervention involved enhanced care coordination efforts in addition to large increases in social support provision, delivered by social workers and nurses in both clinic and non-clinic settings. Participating clinics’ reimbursement rates were raised to parity with those of private payers, representing a fee increase of 30-60%.

We use a pre-post design with contemporaneous controls (“differences-in-differences”) within an intent-to-treat framework. The treatment group is comprised of women receiving care at one of 10 intervention clinics and the comparison group is comprised of women receiving care at one of 20 propensity-score matched comparison clinics. Estimates are generated using standard multivariate regression techniques and are clustered at the clinic level. The pre-period spans 2009-2010 and the post-period spans 2011-2013. The analytic sample is constructed from two administrative data sources: medical records (i.e. encounter) data, and Medicaid application/enrollment data; the final analytic sample includes approximately 13,500 women. Outcomes are appropriate prenatal and postpartum health care utilization measures, including dental care receipt, ambulatory care sensitive emergency room visits, and timely post-partum care receipt.

Preliminary results suggest that the intervention was effective in promoting appropriate prenatal and postpartum care utilization, with the largest impact seen for the probability of having a dental visit (magnitude of the impact reflects an approximate doubling of the baseline proportion of 0.19). Importantly, these estimates align with the results from a complementary qualitative implementation study, during which providers discussed extensive efforts to connect patients to dental care. Results are robust to a variety of specification checks, including choice of comparison clinics. Future analysis will incorporate outcome measures drawn from vital statistics data, with a specific focus on gestational age and birth weight.

In conclusion, we find that a PCMH model grounded in the provision of social support services improved appropriate health care utilization among high-risk pregnant Medicaid members.