This study is a retrospective analysis of medical claims of individuals with diabetes enrolled in managed Medicaid as well as a diabetes management program. The sample consists of 695 individuals who had at least two hospitalizations in one calendar year. This study had two related aims. The first was to examine factors associated with an increased risk of repeat hospitalizations. The second was to determine an appropriate alternative to rehospitalization. Using negative binominal regression, we find that members most likely to be rehospitalized have congestive heart failure or psychosis. We suggest that rehospitalizations in this population may be mitigated by providing home healthcare.

The passage of the Patient Protection and Affordable Care Act of 2010 (PPACA) may create an estimated 16 million new Medicaid enrollees. This underscores the need to develop innovative strategies to provide efficient care to this population without compromising quality. To address concerns that consumer-driven health plans (CDHPs) and cost sharing discourage individuals from seeking needed care, we examined the Healthcare Effectiveness Data Information Set (HEDIS) measures of secondary prevention for a CDHP offered to uninsured, non-Medicaid eligible adults with incomes under 200% of the federal poverty level and compared them to the National Committee for Quality Assurance (NCQA) benchmarks achieved by national Medicaid and commercially insured health plans. Results suggest that the cost-sharing component in the CDHP plan did not deter these low-income enrollees from pursuing or receiving appropriate care when compared to either Medicaid or commercially insured populations. As these results are only descriptive and not statistical measures, further research is needed with comparable populations and more detailed data for hypothesis testing.

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