Medicaid Managed Care Program Improves Outcomes in Disabled Enrollees

Expansion of a new healthcare program in Texas that covers disabled adults on Medicaid has seen improved outcomes in those suffering from chronic pulmonary obstructive disease (COPD) or those who have had a heart attack.

The STAR+PLUS Medicaid managed care program that was evaluated in the study is a home and community-based service (HCBS). Formulated by Medicaid, HCBS programs cater to specific targeted populations and are an alternative to institutional care. In the current study, published in Medical Care, the authors compared quality of care rendered before and after a mandatory transition of disabled Medicaid enrollees (over 21 years old), from fee-for-service (FFS) or primary care case management (PCCM) to STAR+PLUS. Results were compared with the outcomes of enrollees who remained in FFS or PCCM models. Data were collected from 28 counties in Texas.

For the 6 quality measures that were evaluated, the authors found that STAR+PLUS enrollees adhered better to the use of β-blockers after discharge following a heart attack (81% adherence posttransition, compared with 49% in the control sample). Similar results were observed in COPD patients—68% adherence to use of systemic corticosteroids and bronchodilators following an event, compared with 39% adherence observed in the control FFS or PCCM population. However, the authors did not observe any difference in routine aspects of care for chronic conditions between the new care delivery model and the traditional model.

The authors attribute the positive results to rigorous and integrated follow-up following an acute event in the managed care program.

"As more and more states look to adopt this model, it is crucial that we examine whether vulnerable populations, like disabled adults, are receiving the type of high-quality care that will promote their health and well-being," said Elizabeth A. Shenkman, PhD, chair of the department of health outcomes and policy in the UF College of Medicine and coauthor of the study, in a statement.