Findings from Kaiser Permanente Oakland Medical Center in the Area of Managed Care Described (Factors Associated With Persistent High Health Care Utilization In Managed Medicaid): Managed Care

2021 OCT 28 (NewsRx) -- By a News Reporter-Staff News Editor at Insurance Daily News -- Research findings on Managed Care are discussed in a new report. According to news reporting originating from Oakland, California, by NewsRx correspondents, research stated, “Prior studies have had difficulty predicting which patients will have persistent high utilization past 1 year within the Medicaid population. The objective of this study was to examine the medical diagnoses at the time of enrollment of patients with persistent high health care utilization over 24 months following enrollment in Medicaid managed care in a large integrated care setting.”

Financial supporters for this research include Kaiser Permanente Northern California Community Benefit grants program, Permanente Medical Group via Health Care Delivery and Policy Section at Kaiser Permanente Division of Research.

Our news editors obtained a quote from the research from Kaiser Permanente Oakland Medical Center, “Retrospective cohort study in a large integrated managed health care system. We identified a cohort of high utilizers (top 5% of health care costs in 2014) and extracted their electronic health record data (2014-2016). Differences in baseline characteristics of high utilizers and the general Medicaid population were determined using bivariate analysis. We used multivariable regression to determine the independent association between medical comorbidities and demographics with persistent high health care utilization over the 2 years following enrollment. Compared with the general Medicaid managed care enrollee population, schizophrenia was the only mental health diagnosis at the time of enrollment associated with persistent high health care utilization (risk ratio [RR], 1.50; 95% CI, 1.20-1.86). Additional characteristics associated with persistent high utilization included age between 31 and 50 years (RR, 1.20; 95% CI, 1.02-1.41), dual enrollment in Medicaid and Medicare (RR, 1.26; 95% CI, 1.09-1.45), chronic pain diagnoses (RR, 1.26; 95% CI, 1.04-1.53), and multimorbidity (RR, 1.43; 95% CI, 1.25-1.63).”

According to the news editors, the research concluded: “Among adults newly enrolled in Medicaid managed care, certain diagnoses noted at the time of enrollment into the plan are associated with persistent high health care utilization over the first 2 years, suggesting that targeting early supportive case management to these individuals could optimize care and reduce health care costs.”

This research has been peer-reviewed.

For more information on this research see: Factors Associated With Persistent High Health Care Utilization In Managed Medicaid. The American Journal of Managed Care, 2021;27(8). The American Journal of Managed Care can be contacted at: Managed Care & Healthcare Communications Llc, 666 Plainsboro Rd, Ste 300, Plainsboro, NJ 08536, USA.

The news editors report that additional information may be obtained by contacting Somalee Banerjee, Kaiser Permanente Oakland Medical Center, Dept Hosp Based Specialty, Oakland, CA 94611, United States. Additional authors for this research include Amy Alabaster, Patricia Kipnis and Alyce S. Adams.

The direct object identifier (DOI) for that additional information is: https://doi.org/10.37765/ajmc.2021.88725. This DOI is a link to an online electronic document that is either free or for purchase, and can be your direct source for a journal article and its citation.

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