Use of Primary Care and Specialty Providers: Findings from the Medical Expenditure Panel Survey.

Background: A comprehensive picture of how the US population engages in specialty care use is lacking, even though redesign models focused on specialty care are becoming more popular.

Objective: To describe the type of provider, primary care or specialist, most often seen by individuals, to test associations between type of provider most often seen and insurance coverage, and to test associations between the number of generalist and specialist visits and insurance coverage.

Design: Cross-sectional analysis of 2013-2016 Medicaid Expenditure Panel Survey.

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.

Medicaid Accountable Care Organizations in Four States: Implementation and Early Impacts.

Unlabelled: Policy Points Maine, Massachusetts, Minnesota, and Vermont leveraged State Innovation Model awards to implement Medicaid accountable care organizations (ACOs). Flexibility in model design, ability to build on existing reforms, provision of technical assistance to providers, and access to feedback data all facilitated ACO development. Challenges included sustainability of transformation efforts and the integration of health care and social service providers.

Impact of Financial Incentives on Service Use, Spending, and Health in Medicaid.

Introduction: The Centers for Medicare and Medicaid Services provided grants to Medicaid programs through the Medicaid Incentives for Prevention of Chronic Diseases program to test whether financial incentives changed the use of healthcare services, Medicaid spending, and health outcomes. Six states implemented programs related to diabetes prevention, weight management, diabetes management, and hypertension management. The purpose of this study is to examine whether receipt of financial incentives increased use of services incentivized by the program; reduced expenditures, inpatient admissions, emergency department visits; and improved health outcomes.

Changes in Utilization and Expenditures for Medicare Beneficiaries in Patient-centered Medical Homes: Findings From the Multi-Payer Advanced Primary Care Practice Demonstration.

Background: Patient-centered medical homes are expected to reduce expenditures by increasing the use of primary care services, shifting care from inpatient to outpatient settings, and reducing avoidable utilization. Under the Multi-Payer Advanced Primary Care Practice (MAPCP) Demonstration, Medicare joined Medicaid and commercial payers in 8 states to support ongoing patient-centered medical home initiatives.

Objective: To evaluate the effects of the MAPCP Demonstration on health care utilization and expenditures for Medicare beneficiaries.

Impact of Medical Homes on Expenditures and Utilization for Beneficiaries With Behavioral Health Conditions.

Objective: Individuals with behavioral health conditions may benefit from enhanced care management provided by a patient-centered medical home (PCMH). In late 2011 and early 2012 Medicare began participating in PCMH initiatives in eight states through the Multi-Payer Advanced Primary Care Practice (MAPCP) demonstration. This study examined how the initiatives addressed the needs of patients with behavioral health conditions and the impacts of the demonstration on expenditures and utilization for this population.

Primary care and specialty providers: an assessment of continuity of care, utilization, and expenditures.

Background: Little is known as to whether medical home principles, such as continuity of care (COC), would have the same effect on health service use for individuals whose primary (or predominant) provider is a specialist instead of a primary care provider (PCP).

Objective: To test associations between health service use and expenditures and (1) beneficiaries' predominant provider type (PCP or specialist) and (2) COC among beneficiaries who primarily see a PCP and those who primarily see a specialist.

Research Design: This is a cross-sectional analysis of Medicare fee-for-service claims data from July 2007 to June 2009.

Impact of state-specific Medicaid reimbursement and eligibility policies on receipt of cancer screening.

Background: Although state Medicaid programs cover cancer screening, Medicaid beneficiaries are less likely to be screened for cancer and are more likely to present with tumors of an advanced stage than are those with other insurance. The current study was performed to determine whether state Medicaid eligibility and reimbursement policies affect the receipt of breast, cervical, and colon cancer screening among Medicaid beneficiaries.

Methods: Cross-sectional regression analyses of 2007 Medicaid data from 46 states and the District of Columbia were performed to examine associations between state-specific Medicaid reimbursement/eligibility policies and receipt of cancer screening.

The Partnership Access Line: evaluating a child psychiatry consult program in Washington State.

Objective: To evaluate a telephone-based child mental health consult service for primary care providers (PCPs).

Design: Record review, provider surveys, and Medicaid database analysis.

Setting: Washington State Partnership Access Line (PAL) program.

Variations in children's dental service use based on four national health surveys.

Objective: To compare estimates of dental service use and delayed dental care across 4 national surveys of children's health.

Methods: Among children 2 to 17 years of age, prevalence estimates of the use of any dental services, preventive dental services, and delayed dental care in the past year were obtained from the 2003 and 2007 National Survey of Children's Health, the 2003-2004 National Health and Nutrition Examination Survey (NHANES), the 2003 and 2007 National Health Interview Survey, and the 2003 and 2007 Medical Expenditure Panel Survey. Trends in parent-reported dental use, including delayed care, by sociodemographic characteristics were assessed by using logistic regression and odds ratios.

Comparative effectiveness of mailed reminder letters on mammography screening compliance.

Objective: Reminder letters are effective at prompting women to schedule mammograms. Less well studied are reminders addressing multiple preventive service recommendations. We compared the effectiveness of a mammogram-specific reminder sent when a woman was due for a mammogram to a reminder letter addressing multiple preventive services and sent on a woman's birthday on mammography receipt.

Health care use and expenditures associated with access to the medical home for children and youth.

Background: The pediatric medical home is an approach to the delivery of family-centered health care. Policy-makers and payers are interested in potential changes to health care utilization and expenditures under this model.

Objective: To test associations between having a medical home and health service use and expenditures among US children and youth.

Medical home access and health care use and expenditures among children with special health care needs.

Objective: To test associations between having a medical home and health services use and expenditures among US children with special health care needs (CSHCN).

Design: Cross-sectional analysis.

Setting: The 2003-2008 Medical Expenditure Panel Surveys.

The medical home, preventive care screenings, and counseling for children: evidence from the Medical Expenditure Panel Survey.

Objective: Little is known about the role of the medical home in promoting essential preventive health care services in the general pediatric population. This study examined associations between having a medical home and receipt of health screenings and anticipatory guidance.

Methods: We conducted a cross-sectional analysis of the 2004-2006 Medical Expenditure Panel Survey (MEPS).