Richard C. Lindrooth

All-payer claims databases (APCDs) comprise claims from multiple payers that can be traced to a single patient. To correctly estimate cost-sharing for an individual patient, we developed an algorithm to reconcile payments from secondary and tertiary payers to claims that are not fully covered by primary insurance. In a Colorado APCD cancer cohort ( n = 70,100), reconciliation of claims across multiple payers markedly lowered estimated cost-sharing for patients with more than one source of coverage ($5,544 (no reconciliation); $5,013 (primary payer only) to $1,580). The largest reductions in cost-sharing after reconciliation were for individuals with Traditional Medicare with Medigap ($6,449→$1,123; Δ = −$5,326), dual Medicare-Medicaid ($4,439→$2,340; Δ = −$2,099), and Medicaid-commercial ($2,708→$2,009; Δ = −$699). Excluding secondary payments from estimates of cost-sharing systematically inflates cost-sharing estimates. A transparent reconciliation algorithm is necessary to correctly estimate cost-sharing and is recommended for researchers and policymakers who use the APCD for estimating costs across payers and to the patient.

Objective: To measure the effect of the adoption of a family‐centered care coordination approach in Colorado's early intervention program on family engagement and goal attainment outcomes.Study Setting and Design: We estimated difference‐in‐difference models to estimate the effect of Colorado's approach to family‐centered care coordination, using Massachusetts as a control group. Massachusetts was chosen because there were no major changes to family‐centered care coordination during our sample period. The primary outcome measures one of four exit reasons: disengagement (measured as lost to follow‐up or withdrawal), achievement of care plan goals before Age 3, no longer eligible due to Age 3, or moved. Multinomial probit models estimated the effect of Colorado's program on the probability of each exit reason. Additional analyses were stratified by child race and ethnicity groups.Data Sources and Analytic Sample: We obtained administrative early intervention data from Massachusetts and Colorado for children who were referred to early intervention in fiscal years 2013–2019 and had a documented exit reason. The full sample includes 103,635 children (n = 20,045 in Colorado; n = 83,590 in Massachusetts).Principal Findings: Participation in Colorado's program was associated with a 4.6 percentage point reduction in family disengagement (p < 0.01) and a 3.5–4.6 percentage point higher likelihood of meeting early intervention care plan goals before Age 3 (p < 0.01). Estimates by race and ethnicity revealed improved engagement of White, Black, and Hispanic families, though only White and Hispanic children were more likely to achieve care plan goals before Age 3.Conclusions: Colorado's family‐centered care coordination intervention improved family engagement with early intervention services, with fewer families lost to follow‐up or withdrawn following early intervention care plan development. These findings can inform evidence‐based recommendations to other states considering family‐centered care coordination solutions to optimize early intervention service delivery and equity.

Patency-adjusted cost of dialysis access maintenance varies by physician specialty and clinical location in Medicare beneficiaries; institutions can eliminate optional operating room and anesthesia... Background Dialysis maintenance interventions account for billions of dollars in U.S. Medicare spending and are performed by multiple medical specialties. Whether Medicare costs differ by physician...

Decisions by states about whether to expand Medicaid under the Affordable Care Act (ACA) have implications for hospitals’ financial health. We hypothesized that Medicaid expansion of eligibility for childless adults prevents hospital closures because increased Medicaid coverage for previously uninsured people reduces uncompensated care expenditures and strengthens hospitals’ financial position. We tested this hypothesis using data for the period 2008–16 on hospital closures and financial performance. We found that the ACA’s Medicaid expansion was associated with improved hospital financial performance and substantially lower likelihoods of closure, especially in rural markets and counties with large numbers of uninsured adults before Medicaid expansion. Future congressional efforts to reform Medicaid policy should consider the strong relationship between Medicaid coverage levels and the financial viability of hospitals. Our results imply that reverting to pre-ACA eligibility levels would lead to particula...

Background: Recent evidence suggests racial disparities exist in post-stroke conditions such as aphasia, yet the underlying cause of such disparities is unclear. Disparities in rehabilitation service utilisation have been previously proposed as a contributor to racial disparities in post-stroke outcomes. Aim: To examine racial differences in speech–language pathology (SLP) service utilisation and costs among persons with aphasia being treated in acute care hospitals in North Carolina. Methods & Procedures: The North Carolina Healthcare Cost and Utilization Project data from 2011 to 2012 were analysed to examine SLP service utilisation and costs for stroke patients with aphasia. Analyses included length of stay (LOS) and charges/costs of SLP services. Generalised linear models were constructed to determine the impact of demographic characteristics, stroke severity, residence, and hospital fixed effects (variability of hospital management practices) on SLP utilisation and costs. Outcomes & Results: Approximately 5% more Blacks with aphasia were seen for SLP services than Whites with aphasia. LOSs were 2.1 days longer in acute care at 17% greater cost. Generalised linear models showed that Blacks with aphasia were seen for approximately 0.416 more visits than Whites after controlling for demographic characteristics, stroke/illness severity and residence and 0.25 more visits after controlling for hospital fixed effects. The slight increase in visits occurred at a cost of $57 when controlling for demographic characteristics, $63 when controlling for stroke/illness severity, $50 when controlling for residence, and $23 when controlling for hospital fixed effects. Conclusions: Blacks with aphasia utilise more SLP services during longer LOSs and with greater costs when compared to Whites with aphasia.

Medicaid quality indicators track diabetes mellitus and cardiovascular disease screening in adults receiving antipsychotics and/or those with serious mental illness. To inform performance improvement interventions by evaluating the relative importance of patient, prescriber, and practice factors affecting metabolic testing. A retrospective cohort study was conducted using Missouri Medicaid administrative claims data (January 1, 2010, to December 31, 2012) linked with prescriber market data. The analysis included 9316 adults (age, 18-64 years) who were starting antipsychotic medication. Secondary analysis included the subset of adults (n = 1813) for whom prescriber knowledge, attitudes, and behavior survey data were available. Generalized estimating equations were performed to identify factors associated with failure to receive annual testing during antipsychotic treatment (adjusted odds ratio [OR], 6 encounters vs none; 0.33 [0.28-0.39]). Analysis incorporating prescriber practice information found lower failure to receive glucose testing if the patient received care at a CMHC (0.74 [0.64-0.85]) or if the initiating prescriber was a primary care practitioner (0.81 [0.66-1.00]). However, the initiating prescriber specialty-setting was not associated with lipid testing. Compared with prior reports, progress has been made to improve diabetes screening, but lipid screening remains particularly underutilized. Medicaid performance improvement initiatives should target all prescriber settings and not just behavioral health.