First name
Lisa
Last name
Biggs

Title

Association of a Targeted Population Health Management Intervention with Hospital Admissions and Bed-Days for Medicaid-Enrolled Children.

Year of Publication

2019

Number of Pages

e1918306

Date Published

2019 Dec 02

ISSN Number

2574-3805

Abstract

<p><strong>Importance: </strong>As the proportion of children with Medicaid coverage increases, many pediatric health systems are searching for effective strategies to improve management of this high-risk population and reduce the need for inpatient resources.</p>

<p><strong>Objective: </strong>To estimate the association of a targeted population health management intervention for children eligible for Medicaid with changes in monthly hospital admissions and bed-days.</p>

<p><strong>Design, Setting, and Participants: </strong>This quality improvement study, using difference-in-differences analysis, deployed integrated team interventions in an academic pediatric health system with 31 in-network primary care practices among children enrolled in Medicaid who received care at the health system's hospital and primary care practices. Data were collected from January 2014 to June 2017. Data analysis took place from January 2018 to June 2019.</p>

<p><strong>Exposures: </strong>Targeted deployment of integrated team interventions, each including electronic medical record registry development and reporting alongside a common longitudinal quality improvement framework to distribute workflow among interdisciplinary clinicians and community health workers.</p>

<p><strong>Main Outcomes and Measures: </strong>Trends in monthly inpatient admissions and bed-days (per 1000 beneficiaries) during the preimplementation period (ie, January 1, 2014, to June 30, 2015) compared with the postimplementation period (ie, July 1, 2015, to June 30, 2017).</p>

<p><strong>Results: </strong>Of 25 460 children admitted to the hospital's health system during the study period, 8418 (33.1%) (3869 [46.0%] girls; 3308 [39.3%] aged ≤1 year; 5694 [67.6%] black) were from in-network practices, and 17 042 (67.9%) (7779 [45.7%] girls; 6031 [35.4%] aged ≤1 year; 7167 [41.2%] black) were from out-of-network practices. Compared with out-of-network patients, in-network patients experienced a decrease of 0.39 (95% CI, 0.10-0.68) monthly admissions per 1000 beneficiaries (P = .009) and 2.20 (95% CI, 0.90-3.49) monthly bed-days per 1000 beneficiaries (P = .001). Accounting for disproportionate growth in the number of children with medical complexity who were in-network to the health system, this group experienced a monthly decrease in admissions of 0.54 (95% CI, 0.13-0.95) per 1000 beneficiaries (P = .01) and in bed-days of 3.25 (95% CI, 1.46-5.04) per 1000 beneficiaries (P = .001) compared with out-of-network patients. Annualized, these differences could translate to a reduction of 3600 bed-days for a population of 93 000 children eligible for Medicaid.</p>

<p><strong>Conclusions and Relevance: </strong>In this quality improvement study, a population health management approach providing targeted integrated care team interventions for children with medical and social complexity being cared for in a primary care network was associated with a reduction in service utilization compared with an out-of-network comparison group. Standardizing the work of care teams with quality improvement methods and integrated information technology tools may provide a scalable strategy for health systems to mitigate risk from a growing population of children who are eligible for Medicaid.</p>

DOI

10.1001/jamanetworkopen.2019.18306

Alternate Title

JAMA Netw Open

PMID

31880799

Title

Consumerism, Innovation, and the Future of Pediatric Primary Care.

Year of Publication

2018

Date Published

2018 Jul 30

ISSN Number

2168-6211

Abstract

<p>Netflix was founded in 1997 to allow consumers access to video content from home. By 2000, focused on second-tier films, Netflix developed a subscription service featuring unlimited, fixed-price rentals. That same year, Netflix approached Blockbuster, the dominant movie rental company at that time, first offering to become Blockbuster’s online retail arm and then to sell itself for $50 million. Both offers were declined. In 2008, Blockbuster declared that Netflix is “not even on the radar screen in terms of competition.”<sup><a class="ref-link section-jump-link" data-tab-toggle=".tab-nav-references" href="https://jamanetwork.com/journals/jamapediatrics/article-abstract/268878…; Failing to recognize Netflix’s ability to satisfy the customer, Blockbuster filed for bankruptcy in 2010. In contrast, Netflix, now with more than 100 million subscribers, achieved dominance by betting on emerging technology for streaming video. What might this example teach us about the future of a very different service, pediatric primary care?</p>

DOI

10.1001/jamapediatrics.2018.1501

Alternate Title

JAMA Pediatr

PMID

30073320

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