Outcomes of Care for Medicaid 2006

Outcomes of care for Iowa Medicaid managed care enrollees
SFY 2006

The current movement to Pay-for-Performance by insurers continues to increase the importance of using valid outcome measures and understanding the results they generate. The Iowa Medicaid program has been involved in utilizing HEDIS outcome measures for over 10 years to improve quality of care. Since 2003, the outcome measures utilized have remained constant and include: well-child visits in the first 15 months of life; well child-visits in the 3^rd, 4^th, 5^th, and 6^th years of life; children and adolescents’ access to primary care providers; annual dental visit; use of appropriate medications for people with asthma; adults’ access to preventive/ambulatory health services; hemoglobin A1c testing; and prenatal and postpartum care.

Outcome measures are computed with regard to the managed care eligible Medicaid population. Most measures require that an enrollee be eligible for at least 11 months of the year for which the measure is being calculated. For well-child visits in the first 15 months of life children must be enrolled for 14 of the first 15 months of life. For prenatal and postpartum care various enrollment periods are utilized to determine the rates.

By coupling the HEDIS outcome measures with the CAHPS survey results, we are able to paint a reliable picture about the care that is received through the Medicaid program. In addition, we are able to compare our rates at the program level with rates from across the nation for other Medicaid programs and a variety of commercial insurers and are able to compare our rates over time.

Eligibility

Within the managed care eligible Medicaid program we have broken the enrollees into three groups: those enrolled in an HMO (Coventry), those in MediPASS, and those in the fee-for-service (FFS) or traditional Medicaid program. For most outcomes, enrollees had to be eligible for at least 11 months during the state fiscal year (SFY) 2006. Of those eligible for at least 11 months during SFY 2006: 4,205 were in an HMO; 109,075 were in MediPASS; and 38,504 were in FFS. A comparison of demographics for this population as compared to the state are shown in Table 1, while the age and gender breakdowns are shown in Table 2.

The population of Medicaid eligible people enrolled in a TANF-related program for at least 11 months during SFY 2006 are younger than the state population. These enrollees are also more likely to be female and non-caucasian. Based on the demographics of this group we know that they will have a more difficult time accessing medical care, once again highlighting the importance of calculating and tracking relevant outcome measures.

The number of people within the program for at least 11 months rose by almost 20% (more than 24,000), from SFY 2005 to SFY 2006. This increase was distributed across all age and gender groups, however the largest increase was for males 19 to 21 years of age with an increase of 29.3% (258 people). However, the most people were added in the category of girls and boys 7–12 years of age.

Table 1: Comparisons of demographics for Medicaid enrollees who were eligible for at least 11 months in SFY 2006 and the state population as estimated by the census

Characteristic	Medicaid Enrollees	State Population
Age group
0–2 years	14.2%	3.7%
3–6 years	21.3%	4.7%
7–12 years	24.5%	7.4%
13–18 years	18.4%	8.1%
19–21 years	3.7%	4.4%
22–44 years	15.9%	31.2%
45–64 years	1.7%	25.6%
65 years and over	0.3%	14.7%
Gender
Male	43.8%	49.2%
Female	56.2%	50.8%
Race
White	61.4%	91.5%
African-American	9.0%	2.3%
Hispanic	5.1%	3.7%
Other including unknown	24.5%	2.5%

Table 2: Medicaid enrollees eligible for at least 11 months by age and gender
SFY 2006

Age group		Female	Male	Total
0–2 years	Number	10,534	10,981	21,515
	Percent	49.0%	51.0%	100.0%
3–6 years	Number	15,909	16,460	32,369
	Percent	49.1%	50.9%	100.0%
7–12 years	Number	18,349	18,817	37,166
	Percent	49.4%	50.6%	100.0%
13–18 years	Number	14,294	13,708	28,002
	Percent	51.0%	49.0%	100.0%
19–21 years	Number	4,436	1,138	5,574
	Percent	79.6%	20.4%	100.0%
22–44 years	Number	19,746	4,402	24,148
	Percent	81.8%	18.2%	100.0%
45–64 years	Number	1,650	942	2,592
	Percent	63.7%	36.3%	100.0%
over 65 years	Number	344	74	418
	Percent	82.3%	17.7%	100.0%
Total	Number	85,262	66,522	151,784
	Percent	56.2%	43.8%	100.0%

Outcome measures

Well-child visits in the first 15 months of life

In accordance with the American Academy of Pediatrics recommendations, the Iowa Department of Public Health (IDPH) Early Periodic Screening, Diagnosis and Treatment (EPSDT) schedule indicates that children should have 8 visits during the first 15 months of life. The EPSDT schedule recommends visits at 2-3 days and 1, 2, 4, 6, 9, 12, and 15 months. There are seven rates computed for this HEDIS measure, one rate for each visit number: no visits, 1 visit, 2 visits, 3 visits, 4 visits, 5 visits, and 6 or more visits. The denominator for these rates is the number of children who turned 15 months of age by June 30, 2006 and were eligible for at least 14 of the first 15 months of their life. The numerator is the number of children who had each number of visits from zero to six or more.

Figure 1 provides a comparison of the rates for zero visits and 6 or more visits for the three groups over the last 3 years (SFY 2004–SFY 2006). This figure indicates that though the proportion of children who had made no visits during the first 15 months of life has not changed dramatically for any of the groups, the proportion of children who received six or more visits has decreased. Though it is unclear why this may be happening, it seems to tell us that though children are getting in to see the doctor, they are not receiving as many visits as are recommended. This may result in a lack of anticipatory guidance for parents, reduce opportunities for development screening by the physician, and interrupted vaccination schedules.

Table 3: Number and proportion of children receiving from zero to
six or more well-child visits in the first 15 months of life
SFY 2006

Number of visits		FFS	MediPASS	HMO	Total
0 visits	Number	240	711	5	956
	Percent	9.4%	10.0%	1.7%	9.6%
1 visit	Number	141	464	11	616
	Percent	5.5%	6.5%	3.7%	6.2%
2 visits	Number	155	394	28	577
	Percent	6.1%	5.5%	9.4%	5.8%
3 visits	Number	224	546	38	808
	Percent	8.8%	7.7%	12.7%	8.1%
4 visits