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Minnesota Medical Home Project: Evaluation Feasibility Study

Minnesota Medical Home Project: Evaluation Feasibility Study. Saturday, June 7, 2008 SHRIG Meeting, Academy Health. What is a Medical Home Model of Care?. Healthy People 2010 Measures Family/Professional Partnership Comprehensive Health Care Access to Health Insurance/Financing

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Minnesota Medical Home Project: Evaluation Feasibility Study

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  1. Minnesota Medical Home Project: Evaluation Feasibility Study Saturday, June 7, 2008 SHRIG Meeting, Academy Health

  2. What is a Medical Home Model of Care? Healthy People 2010 Measures • Family/Professional Partnership • Comprehensive Health Care • Access to Health Insurance/Financing • Early/Continuous Screening • Access to Community Services • Transition to Adult Life Minnesota Medical Home Project • Coordination of Care

  3. Who are Children with Special Health Care Needs (CSHCN)?

  4. Children with Special Health Care Needs…….. ”…have or are at increased risk for a chronic physical, developmental, behavioral, or emotional condition and who also require health and related services of a type or amount beyond that required by children generally (DHHS, 2004).”

  5. What is the Minnesota Medical Home Project (MMHP)? • Goal: provide comprehensive patient-centered care to children with special health care needs • MNCSHN Section, MN Department of Health + partners • Formed in 2004 with 11 primary care teams from practices around Minnesota • Healthy People 2010 Objective 16-23

  6. Slide credit: Carolyn Allshouse, MCSHCN/MDH

  7. MMHP Evaluation Components: • Family Perception Survey • Medical Home Index - MDH/MCSHN • Time Study - DHS/PMQI • 2001/2005 National CSHCN Survey

  8. What is an Evaluation Feasibility Study? Determine whether the impact of the medical home model of care on the health service utilization and costs of care of Medicaid-enrolled children with special health care needs is feasible to assess. Impact= More Appropriate Care

  9. Study Participants Medical Home children (n = 513) • intervention group; identified by providers • 9 clinics throughout Minnesota Two comparison groups of CSHCN identified from Minnesota Medicaid administrative data • “Internal”: same clinics, different MDs (n = 732) • “External”: no contact with Project (n = 15,042)

  10. Study Inclusion Criteria • 0-18 years old • CSHCN status identified by a Project provider or by Minnesota Health Care Programs’ (MHCP) administrative claims data • enrolled for a minimum of one month per year in MHCP; all 3 years of the study

  11. Analysis Methods • Repeated measure mixed design multivariate regression analysis • Re-run analysis on random sample of the comparison groups • All statistical models controlled for differences in age, gender, race/ethnicity, metro/non-metro status, parental marital status, and health status across study groups.

  12. Preliminary Results

  13. Health Condition Over Time Association with Intervention Status

  14. Medical Home Children: PMPM Inpatient Admissions

  15. Inpatient Admissions by Study Group (PMPM Adjusted Rate) 0.06 External Sample n=513 0.05 Internal Sample n=513 Medical Home Sample n=513 0.04 PMPM Adjusted Rate 0.03 0.02 0.01 0 Baseline (03/1/03- Year 1 (03/01/04- Year 2 (03/01/05- 02/29/04) 02/28/05) 02/28/06) Study Period Draft

  16. Medical Home Children: PMPM Emergency Department Visits

  17. Emergency Department Visits by Study Group (PMPM Adjusted Rate)

  18. Medical Home Children:PMPM Well Child Visits

  19. Well Child Visits by Study Group (PMPM Adjusted Rate)

  20. Medical Home Children:PMPM Dental Visits

  21. Dental Visits by Study Group (PMPM Adjusted Rate)

  22. Any Well Child Year 2 Visit: Predictors

  23. Any Well Child Year 2 Visit: Intervention Effect by Age

  24. Any Dental Year 2 Visit: Predictors

  25. Inpatient Admissions by Enrollee Care Plan StatusPMPM rate over time; medical home participants only; overall PMPM rate is not adjusted

  26. Emergency Department Visits by Enrollee Care Plan StatusPMPM rate over time; medical home participants only; overall PMPM rate is not adjusted

  27. Fee-For-Service PMPM Costs: All Study GroupsPercent by Category of ServiceMarch 1, 2003 - February 28, 2006 *Only children with 4+ months FFS enrollment in each study year

  28. Fee-For-Service PMPM Costs by Category of Service and Study Group March 1, 2003 - February 28, 2006*Only children with 4+ months FFS enrollment in each study year.

  29. Fee-For-Service PMPM Costs: All Study GroupsBy Age of Child at Baseline*All Categories of Service except long-term care*Only children with 4+ months FFS enrollment in each study year.

  30. Fee-For-Service PMPM Costs: All Study GroupsBy Severity of Condition at Baseline*All Categories of Service except long-term care*Only children with 4+ months FFS enrollment in each study year.

  31. Any Year 2 Health Services:Association with Medical Home Clinics

  32. Inpatient Admissions by Medical Home Status of Clinics*overall PMPM rates are not adjusted

  33. Emergency Department PMPM Visits by Medical Home Status of Clinics*overall PMPM rates are not adjusted

  34. Preliminary Results: Potential Impact Rates decreased over time • IP Admissions • Medical supply claims (steepest for MH) Increased likelihood of any Year 2 dental visits well-child visits for 0-6 year olds Care plans associated with decreased IP admissions

  35. Preliminary Results: Learnings “Appropriate care” measures • multiple categories of service • do not look at utilization/cost in isolation CSHCN ascertainment methodology • initial comparison group analysis More standardization and/or data needed from the medical home teams

  36. Preliminary Analysis: Limitations • Selection Bias • Outcomes defined as cost and/or utilization offsets rather than quality of life, other externalities • Exposure Misclassification and Measurement Error • Administrative Data

  37. Preliminary Results: Feasibility? Can the medical home program be evaluated using administrative data? Answer: Only provides a partial picture…..

  38. Future Research Directions • Revise control group ascertainment method • Relative weight analysis to better evaluate the overall impact of the MMHP • Develop CSHCN-specific performance measures • Standardize and measure medical home “exposure” • Evaluate the sensitivity/specificity of administrative data for CSHCN

  39. Funding Source/Grant Number MNDHS and MCSHCN/MDH staff (Jon Huus, Jeff Tenney, Greg Gifford) Medical home teams and participants Tonga Nfor, MD Acknowledgements

  40. Authors: Muree Larson-Bright, PhD Susan Castellano Tonga Nfor, MD Minnesota Department of Human Services Performance Measurement and Quality Improvement Maternal and Child Health Assurance 651.431.2635 muree.larson-bright@state.mn.us

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