Quality of Care Associated with Common Chronic Diseases in a 9-State Medicaid Population Utilizing Claims Data: An Evaluation of Medication and Health Care Use and Costs

Priest, Julie; Cantrell, C. Ron; Fincham, Jack E.; Cook, Constance E.; Burch, Steven

doi:10.1089/pop.2010.0019

Cited by 32 publications

(33 citation statements)

References 24 publications

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“…Even among those patients who did refill the LTC-Rx, only 16% were consistent in adhering to therapy for 6 months (i.e. medication possession ratio >0.8) [20]. In the four-state sample of the National Asthma Survey, over half (52.8%) of patients with persistent asthma did not report receiving an inhaled corticosteroid, even though they should have been receiving a long-term controller therapy.…”

Section: Discussionmentioning

confidence: 99%

Inhaled corticosteroid adherence and emergency department utilization among Medicaid-enrolled children with asthma

2013

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Objectives Asthma is the most prevalent chronic disease among children enrolled in Medicaid. This study measured real-world adherence and outcomes after an initial prescription for inhaled corticosteroid therapy in a multi-state Medicaid population. Methods We conducted a retrospective study among Medicaid-enrolled children aged 5–12 years with asthma in 14 southern states using 2007 Medicaid Analytic eXtract file claims data to assess adherence and outcomes over the 3 months following an initial prescription drug claim for inhaled corticosteroids (ICS-Rx). Adherence was measured by the long-term controller-to-total asthma drug claims ratio. Results Only one-third of children (33.4%) with an initial ICS-Rx achieved a controller-to-total drug ratio >0.5 over the next 90 days. Children for whom long-term control drugs represented less than half of their total asthma drug claims had a 21% higher risk of emergency department (ED) visit (adjusted odds ratio (AOR) 1.21 [95% CI 1.14, 1.27]), and a 70% higher risk of hospital admission (AOR 1.70 [95% CI 1.45, 1.98]) than those with a controller-to-total asthma drug ratio >0.5. Conclusion Real-world adherence to long-term controller medications is quite low in this racially diverse, low-income segment of the population, despite Medicaid coverage of medications. Adherence to long-term controller therapy had a measurable impact on real-world outcomes. Medicaid programs are a potential surveillance system for both medication adherence and ED utilization.

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Section: Discussionmentioning

confidence: 99%

Inhaled corticosteroid adherence and emergency department utilization among Medicaid-enrolled children with asthma

2013

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“…HCC categories were grouped into 5 major chronic disease groups for risk adjustment: Cerebral (HCC 097–099), Heart (HCC 083–084), Vascular (HCC 104–105), Cancer (HCC 007–010), Diabetes (HCC 015–020) and Arrhythmias (HCC 092–093). These conditions are common among veterans and are associated with higher costs of care [18–21]. A patient might be found in multiple conditions, if more than one was documented.…”

Section: Methodsmentioning

confidence: 99%

Association between health literacy and medical care costs in an integrated healthcare system: a regional population based study

Haun

Patel

French

et al. 2015

BMC Health Serv Res

146

106

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BackgroundLow health literacy is associated with higher health care utilization and costs; however, no large-scale studies have demonstrated this in the Veterans Health Administration (VHA). This research evaluated the association between veterans’ health literacy and their subsequent VHA health care costs across a three-year period.MethodsThis retrospective study used a Generalized Linear Model to estimate the relative association between a patient’s health literacy and VHA medical costs, adjusting for covariates. Secondary data sources included electronic health records and administrative data in the VHA (e.g., Medical and DCG SAS Datasets and DSS-National Data Extracts). Health literacy assessments and identifiers were electronically retrieved from the originating health system. Demographic and cost data were retrieved from the VHA centralized databases for the corresponding patients who had VHA use in all three years.ResultsIn a study of 92,749 veterans with service utilization from 2007–2009, average per patient cost for those with inadequate and marginal health literacy was significantly higher ($31,581 [95 % CI: $30,186 - $32,975]; $23,508 [95 % CI: $22,749 - $24,268]) than adequate health literacy ($17,033 [95 % CI: $16,810 - $17,255]). Estimated three-year cost associated with veterans’ with marginal and inadequate health literacy was $143 million dollars more than those with adequate health literacy.ConclusionsAnalyses suggest when controlling for other person-level factors within the VHA integrated healthcare system, lower health literacy is a significant independent factor associated with increased health care utilization and costs. This study confirms the association of lower health literacy with higher medical service utilization and pharmacy costs for veterans enrolled in the VHA. Confirmation of higher costs of care associated with lower health literacy suggests that interventions might be designed to remediate health literacy needs and reduce expenditures. These analyses suggest 17.2 % (inadequate & marginal) of the Veterans in this population account for almost one-quarter (24 %) of VA medical and pharmacy cost for this 3-year period. Meeting the needs of those with marginal and inadequate health literacy could produce potential economic savings of approximately 8 % of total costs for this population.

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“…Across 9 states, only 27% of adult asthma patients on Medicaid refilled a prescribed longterm controller medication prescription (LTC-Rx) at least twice. 18 Among patients who did refill the LTC-Rx, only 16% adhered to therapy consistently for 6 months. Higher adherence to long-term controller therapy is associated with lower ED visit rates, 19,20 but ICS-Rx adherence under ''real world'' conditions among Medicaid-enrolled children with asthma is only 20%.…”

Section: Asthma Emergency Visits After Ics-rxmentioning

confidence: 99%

Timing of Emergency Department Visits for Childhood Asthma after Initial Inhaled Corticosteroid Use

Rust

Zhang²,

Holloway³

et al. 2015

Population Health Management

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Inhaled corticosteroids can prevent acute exacerbations and emergency visits when used as part of a chronic care plan for long-term control of asthma, but low patient adherence and inadequate provider prescribing (clinical inertia) can limit these benefits. State Medicaid programs are a major source of insurance coverage for low-income children, paying for medications and preventive care, as well as bearing the cost of adverse outcomes for common chronic conditions in childhood, such as asthma. This study measured the incidence and timing of emergency department (ED) visits in the first 90 days after an initial inhaled corticosteroid prescription (ICS-Rx) among 43,156 Medicaid-enrolled children with a diagnosis of asthma in 14 southern states in 2007. One in 5 children (19.6%) with asthma had at least 1 ED visit in the first 90 days after initial ICS-Rx; 10% of these visits occurred within the first 48 hours, and 25% occurred within the first week. Continued ICS-Rx use was associated with lower risk of an ED visit. There were no racial differences in the ED visit rates. Initial ICSRx for Medicaid-enrolled children is a warning flag for short-term risk of asthma-related ED visits, whereas continued ICS-Rx use is protective for at least 90 days. Primary care follow-up may be needed within the first 2 days after initial ICS-Rx to prevent adverse outcomes. Medicaid programs could use claims data for surveillance of adherence to guideline-concordant therapy and for sentinel events marking windows of a higher risk for ED visits.

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Quality of Care Associated with Common Chronic Diseases in a 9-State Medicaid Population Utilizing Claims Data: An Evaluation of Medication and Health Care Use and Costs

Cited by 32 publications

References 24 publications

Inhaled corticosteroid adherence and emergency department utilization among Medicaid-enrolled children with asthma

Inhaled corticosteroid adherence and emergency department utilization among Medicaid-enrolled children with asthma

Association between health literacy and medical care costs in an integrated healthcare system: a regional population based study

Timing of Emergency Department Visits for Childhood Asthma after Initial Inhaled Corticosteroid Use

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