minnesota medical home project evaluation feasibility study
Download
Skip this Video
Download Presentation
Minnesota Medical Home Project: Evaluation Feasibility Study

Loading in 2 Seconds...

play fullscreen
1 / 44

Minnesota Medical Home Project: Evaluation Feasibility Study - PowerPoint PPT Presentation


  • 219 Views
  • Uploaded on

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

loader
I am the owner, or an agent authorized to act on behalf of the owner, of the copyrighted work described.
capcha
Download Presentation

PowerPoint Slideshow about 'Minnesota Medical Home Project: Evaluation Feasibility Study' - trinh


An Image/Link below is provided (as is) to download presentation

Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -
Presentation Transcript
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
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
children with special health care needs
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).”

what is the minnesota medical home project mmhp
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
slide6
Slide credit:

Carolyn Allshouse, MCSHCN/MDH

mmhp evaluation components
MMHP Evaluation Components:
  • Family Perception Survey
  • Medical Home Index - MDH/MCSHN
  • Time Study - DHS/PMQI
  • 2001/2005 National CSHCN Survey
what is an evaluation feasibility study
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

study participants
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)
study inclusion criteria
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
analysis methods
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.
health condition over time association with intervention status
Health Condition Over Time

Association with Intervention Status

inpatient admissions by study group pmpm adjusted rate
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

any well child year 2 visit intervention effect by age
Any Well Child Year 2 Visit:

Intervention Effect by Age

slide29
Inpatient Admissions by Enrollee Care Plan StatusPMPM rate over time; medical home participants only; overall PMPM rate is not adjusted
slide30
Emergency Department Visits by Enrollee Care Plan StatusPMPM rate over time; medical home participants only; overall PMPM rate is not adjusted
slide31
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
slide32
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.
slide33
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.
slide34
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.
inpatient admissions by medical home status of clinics overall pmpm rates are not adjusted
Inpatient Admissions by Medical Home Status of Clinics*overall PMPM rates are not adjusted
slide37
Emergency Department PMPM Visits by Medical Home Status of Clinics*overall PMPM rates are not adjusted
preliminary results potential impact
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

preliminary results learnings
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

preliminary analysis limitations
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
preliminary results feasibility
Preliminary Results: Feasibility?

Can the medical home program

be evaluated using

administrative data?

Answer:

Only provides a partial picture…..

future research directions
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
acknowledgements
Funding Source/Grant Number

MNDHS and MCSHCN/MDH staff (Jon Huus, Jeff Tenney, Greg Gifford)

Medical home teams and participants

Tonga Nfor, MD

Acknowledgements
slide44
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

[email protected]

ad