Managing Health Care for Medicaid Recipients with Disabilities
Final Report on the Colorado Access Coordinated Care Pilot Program
Coordinated care programs are designed to address problems that can arise when individuals with multiple chronic conditions seek health care. Their health care needs might require attention from several doctors, which can result in duplicative tests or prescriptions for contraindicated medications. Coordinated care programs attempt to minimize these problems by using care managers to assess individuals’ health care needs and help them make appropriate use of the health care system. Such programs may be an important policy option for aged and disabled Medicaid recipients, who account for almost 75 percent of Medicaid spending.
This report presents two-year results from an MDRC evaluation of a pilot coordinated care program run by Colorado Access, a nonprofit health plan. As part of this program, Colorado Access care managers’ goals included encouraging individuals to see their primary care providers, assessing health care and social service needs, providing educational information about medical conditions, coordinating care across providers, and helping individuals make and keep medical appointments. The program aimed to improve the quality of care while reducing Medicaid costs by helping individuals use appropriate care that would reduce hospital admissions and emergency department visits.
To understand whether the Colorado Access program had effects, more than 5,000 blind or disabled Medicaid recipients in five Denver-area counties were assigned at random to either a program group, which had access to the coordinated care program, or a control group, which did not. In total, 3,540 people were assigned to the program group and 1,524 were assigned to the control group.
- Care managers faced several challenges implementing the program. Because many clients were difficult to reach (as a result of nonworking telephone numbers or a change of address without notification, for example), care managers had trouble contacting them and engaging them in services, and faced large caseloads that precluded frequent contact with most individuals.
- The program had little effect on health care use. The frequency of doctor visits, hospital admissions, emergency room visits, and use of prescription medications was similar for the program group and the control group. The program did increase the use of providers who are not medical doctors, such as optometrists and podiatrists.
- Results from more effective coordinated care programs suggest several ways to improve the design of the program. More effective programs have used in-person contact, targeted individuals at high risk of hospitalization, and focused on managing transitions from hospital to home. By contrast, Colorado Access care management took place primarily by telephone, included a broad cross-section of Medicaid recipients with disabilities, and had limited information on hospital admissions.
Although these results suggest that the program had little effect, it is possible that the effects would have increased after the second year. Furthermore, the quality of care, the use of social services, and patients’ satisfaction with care were not measured in this evaluation, so the program’s effects on those outcomes are unknown.