Coordinated care programs are designed to address problems that can arise when individuals with multiple chronic conditions seek health care. They might need attention from several doctors, which can result in duplicative tests or prescriptions for contraindicated medications. Coordinated care programs attempt to minimize these problems by helping individuals 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 Kaiser Permanente Colorado, which is part of the Kaiser Permanente managed care consortium. Kaiser Permanente Colorado care managers assessed each individual’s health care and social service needs, provided educational information about medical conditions, coordinated care across providers, and helped 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 is intended to reduce hospital admissions and emergency department visits.
To understand whether the Kaiser Permanente Colorado program had effects, about 2,600 blind or disabled Medicaid recipients in two 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.
- Care managers faced a number of challenges implementing the program. For example, they had difficulty contacting eligible individuals, who did not always have a permanent address or phone service.
- The program increased the use of specialists and nonphysician providers, but had little effect on other aspects of health care use. The frequency of primary care visits, hospital admissions, emergency department visits, and use of prescription medications was similar for the program and control groups. The program did increase the use of specialists, perhaps because individuals could use specialists from the Kaiser Permanente system. It also increased care from providers who are not medical doctors, such as optometrists and physical therapists.
- Results from other coordinated care programs suggest how to improve program design. More effective programs have used in-person contact, targeted individuals at high risk of hospitalization, and focused on managing transitions from hospital to home. In contrast, Kaiser Permanente Colorado care management occurred mostly by telephone, included a broad cross-section of disabled Medicaid recipients, and did not have information on hospital admissions outside the Kaiser Permanente system.
Although the program had only modest effects on health care use, they were generally more positive than for a similar pilot run by Colorado Access. This disparity may reflect differences in the pilots. For instance, Kaiser Permanente care managers and providers used one electronic records system, which was not the case for Colorado Access. In addition, the evaluation did not measure quality of care, use of social services, and patients’ satisfaction with care, which were all program goals.