Impact of a statewide medicaid managed care system on healthcare utilization and outcomes for people living with HIV

James Bailey, David L. Van Brunt, Grant W. Somes, Craig Dorko, Jim Wan

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Medicaid managed care (MMC) systems provide insurance for many persons living with HIV and AIDS (PLWH). This study sought to assess the impact of a statewide MMC system (TennCare) on healthcare utilization and outcomes for PLWH. Methods: A retrospective longitudinal analysis of trends in population characteristics was performed. The study population included all Tennessee PLWH identified by State Health Department, enrolled for 1 year or longer in Medicaid (1992-1993) or TennCare (1994-1997). Main outcome measures included health care utilization, incidence of opportunistic infections, and mortality. Results: From 1992 to 1997, the following decreased: average number of hospitalizations for HIV (0.72 to 0.37) and AIDS (1.27 to 0.52); emergency visits for HIV (1.70 to 1.12) and AIDS (1.65 to 1.02); outpatient visits for HIV (5.94 to 5.00) and AIDS (8.37 to 7.35), percentage of persons diagnosed with Pneumocystis carinii pneumonia for AIDS (10% to 6%) and percentage of persons diagnosed with community-acquired pneumonia for HIV (14% to 9%) and AIDS (27% to 12%), annual incidence of AIDS in the HIV population (33% to 10%), and annual mortality for HIV (3% to 1%) and AIDS (16% to 3%). The average number of antiretroviral medication prescriptions filled increased for HIV (1.27 to 2.45) and AIDS (1.31 to 3.34). Conclusions: This study documents improvements in utilization patterns, morbidity, and mortality in a statewide MMC system. These findings suggest that MMC patients are benefiting from recent advances in therapy.

Original languageEnglish (US)
Pages (from-to)305-314
Number of pages10
JournalAmerican Journal of the Medical Sciences
Volume328
Issue number6
DOIs
StatePublished - Jan 1 2004

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Medicaid
Managed Care Programs
Acquired Immunodeficiency Syndrome
HIV
Delivery of Health Care
Mortality
Patient Acceptance of Health Care
Pneumocystis Pneumonia
Incidence
Opportunistic Infections
Population Characteristics
Insurance
Population
Prescriptions
Pneumonia
Hospitalization
Emergencies
Outpatients
Outcome Assessment (Health Care)
Morbidity

All Science Journal Classification (ASJC) codes

  • Medicine(all)

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Impact of a statewide medicaid managed care system on healthcare utilization and outcomes for people living with HIV. / Bailey, James; Van Brunt, David L.; Somes, Grant W.; Dorko, Craig; Wan, Jim.

In: American Journal of the Medical Sciences, Vol. 328, No. 6, 01.01.2004, p. 305-314.

Research output: Contribution to journalArticle

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abstract = "Background: Medicaid managed care (MMC) systems provide insurance for many persons living with HIV and AIDS (PLWH). This study sought to assess the impact of a statewide MMC system (TennCare) on healthcare utilization and outcomes for PLWH. Methods: A retrospective longitudinal analysis of trends in population characteristics was performed. The study population included all Tennessee PLWH identified by State Health Department, enrolled for 1 year or longer in Medicaid (1992-1993) or TennCare (1994-1997). Main outcome measures included health care utilization, incidence of opportunistic infections, and mortality. Results: From 1992 to 1997, the following decreased: average number of hospitalizations for HIV (0.72 to 0.37) and AIDS (1.27 to 0.52); emergency visits for HIV (1.70 to 1.12) and AIDS (1.65 to 1.02); outpatient visits for HIV (5.94 to 5.00) and AIDS (8.37 to 7.35), percentage of persons diagnosed with Pneumocystis carinii pneumonia for AIDS (10{\%} to 6{\%}) and percentage of persons diagnosed with community-acquired pneumonia for HIV (14{\%} to 9{\%}) and AIDS (27{\%} to 12{\%}), annual incidence of AIDS in the HIV population (33{\%} to 10{\%}), and annual mortality for HIV (3{\%} to 1{\%}) and AIDS (16{\%} to 3{\%}). The average number of antiretroviral medication prescriptions filled increased for HIV (1.27 to 2.45) and AIDS (1.31 to 3.34). Conclusions: This study documents improvements in utilization patterns, morbidity, and mortality in a statewide MMC system. These findings suggest that MMC patients are benefiting from recent advances in therapy.",
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