Health Care Impacts Of Resource Navigation For Health-Related Social Needs In The Accountable Health Communities Model.

Social determinants of health can adversely affect health and therefore lead to poor health care outcomes. When it launched in 2017, the Accountable Health Communities (AHC) Model was at the forefront of US health policy initiatives seeking to address social determinants of health. The AHC Model, sponsored by the Centers for Medicare and Medicaid Services, screened Medicare and Medicaid beneficiaries for health-related social needs and offered eligible beneficiaries assistance in connecting with community services.

Effects of Global Budget Payments on Vulnerable Medicare Subpopulations in Maryland.

There is little evidence regarding population equity in alternative payment models (APMs). We aimed to determine whether one such APM, the Maryland All-Payer Model (MDAPM), had differential effects on subpopulations of vulnerable Medicare beneficiaries. We utilized Medicare fee-for-service claims for beneficiaries living in Maryland and 48 comparison hospital market areas between 2011 and 2018.

Impacts of Maryland's Global Budgets on Medicare and Commercial Spending and Utilization.

In 2014, Maryland incorporated global budgets into its long-running all-payer rate-setting model for hospitals in order to improve health, increase health care quality, and reduce spending. We used difference-in-differences models to estimate changes in Medicare and commercial insurance utilization and spending in Maryland relative to a hospital-based comparison group. We found slower growth in Medicare hospital spending in Maryland than in the comparison group 4.

Early impact of the implementation of Medicaid episode-based payment reforms in Arkansas.

Objective: To evaluate episode-based payments for upper respiratory tract infections (URI) and perinatal care in Arkansas's Medicaid population.

Study Setting: Upper respiratory infection and perinatal episodes among Medicaid-covered individuals in Arkansas and comparison states from fiscal year (FY) 2011 to 2014.

Study Design: Cross-sectional observational analysis using a difference-in-difference design to examine outcomes associated with URI and perinatal episodes of care (EOC) from 2011 to 2014.

Maryland's Global Hospital Budgets: Impacts on Medicare Cost and Utilization for the First 3 Years.

Background: Global budgets have been proposed as a way to control health care expenditures, but experience with them in the United States is limited. Global budgets for Maryland hospitals, the All-Payer Model, began in January 2014.

Objectives: To evaluate the effect of hospital global budgets on health care utilization and expenditures.

Behavioral Health Integration With Primary Care: Implementation Experience and Impacts From the State Innovation Model Round 1 States.

Unlabelled: Policy Points Individuals with behavioral health (BH) conditions comprise a medically complex population with high costs and high health care needs. Considering national shortages of BH providers, primary care providers serve a critical role in identifying and treating BH conditions and making referrals to BH providers. States are increasingly seeking ways to address BH conditions among their residents.

States Encouraging Value-Based Payment: Lessons From CMS's State Innovation Models Initiative.

Unlabelled: Policy Points Six states received $250 million under the federal State Innovation Models (SIM) Initiative Round 1 to increase the proportion of care delivered under value-based payment (VBP) models aligned across multiple payers. Multipayer alignment around a common VBP model occurred within the context of state regulatory and purchasing policies and in states with few commercial payers, not through engaging many stakeholders to act voluntarily. States that made targeted infrastructure investments in performance data and electronic hospital event notifications, and offered grants and technical assistance to providers, produced delivery system changes to enhance care coordination even where VBP models were not multipayer.

Maternal depressive symptoms and healthcare expenditures for publicly insured children with chronic health conditions.

This study estimated the prevalence of maternal depressive symptoms and tested associations between maternal depressive symptoms and healthcare utilization and expenditures among United States publicly insured children with chronic health conditions (CCHC). A total of 6,060 publicly insured CCHC from the 2004-2009 Medical Expenditure Panel Surveys were analyzed using negative binomial models to compare healthcare utilization for CCHC of mothers with and without depressive symptoms. Annual healthcare expenditures for both groups were compared using a two-part model with a logistic regression and generalized linear model.

Effects of early dental office visits on dental caries experience.

Objectives: We determined the association between timing of a first dentist office visit before age 5 years and dental disease in kindergarten.

Methods: We used North Carolina Medicaid claims (1999-2006) linked to state oral health surveillance data to compare caries experience for kindergarten students (2005-2006) who had a visit before age 60 months (n=11,394) to derive overall exposure effects from a zero-inflated negative binomial regression model. We repeated the analysis separately for children who had preventive and tertiary visits.

Cost-effectiveness of alternative treatments for depression in low-income women.

Background: Low-income mothers are more likely to experience depressive symptoms than their higher income counterparts, but they are less likely to receive treatment. One way to overcome common barriers to care for low-income women is to do therapy in the mother's home.

Aims Of The Study: The objective of this study was to compare the cost-effectiveness of in-home interpersonal therapy (IPT) to two standard therapies for depression treatment: office based cognitive behavioral therapy (CBT) and psychotropic medication.

Accuracy of record linkage software in merging dental administrative data sets.

Objective: To determine the accuracy of record matching using "Link King" software that uses an ordinal score for the certainty that linked records are valid matches.

Methods: We linked records in North Carolina Medicaid files to public health surveillance files using Link King matching software. We selected a stratified random sample of 230 of 45,295 linked records and 50 of 35,119 non-linked surveillance records, then manually reviewed the records.

Pediatricians' assessments of caries risk and need for a dental evaluation in preschool aged children.

Background: Risk-based prioritization of dental referrals during well-child visits might improve dental access for infants and toddlers. This study identifies pediatrician-assessed risk factors for early childhood caries (ECC) and their association with the need for a dentist's evaluation.

Methods: A priority oral health risk assessment and referral tool (PORRT) for children < 36 months was developed collaboratively by physicians and dentists and used by 10 pediatricians during well-child visits.

Effect of early preventive dental visits on subsequent dental treatment and expenditures.

Objective: Professional organizations recommend a preventive dental visit by 1 year of age. This study compared dental treatment and expenditures for Medicaid children who have a preventive visit before the age of 18 months with those who have a visit at age 18-42 months.

Methods: This retrospective cohort study used reimbursement claims for 19,888 children enrolled in North Carolina Medicaid (1999-2006).

Primary health care providers' advice for a dental checkup and dental use in children.

Objective: In this study we estimated factors associated with children being advised to see the dentist by a doctor or other health provider; tested for an association between the advisement on the likelihood that the child would visit the dentist; and estimated the effect of the advisement on dental costs.

Methods: We identified a sample of 5268 children aged 2 to 11 years in the 2004 Medical Expenditures Panel Survey. A cross-sectional analysis with logistic regression models was conducted to estimate the likelihood of the child receiving a recommendation for a dental checkup, and to determine its effect on the likelihood of having a dental visit.

Dental care utilization and expenditures in children with special health care needs.

Background: The authors compared children with special health care needs (CSHCN) and children without special health care needs (SHCN) with respect to the odds, amount and determinants of having any dental care and dental care expenditures.

Methods: The authors assessed data from the 2004 Medical Expenditures Panel Survey, Agency for Healthcare Research and Quality, to identify a sample of 8,518 children aged 2 to 17 years. The authors used logistic regression to determine the effect of having SHCN on the probability of having any dental care expenditure, for total dental care expenditures and procedure-specific expenditures.

Distance to care and relative supply among pediatric surgical subspecialties.

Background/purpose: The aim of this study is to describe geographic proximity to and quantify relative supply of 7 pediatric surgical specialties in the United States.

Methods: Data from the 2005 American Medical Association Physician Masterfile and the Claritas Pop-Facts Database were used to calculate subspecialty-specific, population-weighted, straight-line distances between each zip code centroid and the nearest provider. These same data sources were used to calculate the percentage of hospital referral regions with a provider, the percentage of the younger than 18 years population living within selected distances of providers, and provider-to-population ratios for each of the pediatric surgical subspecialties.