Article

The study used a retrospective pretest, posttest design of 245
beneficiaries. Physical impairment ranged from slight to severe. SETTING:
Minnesota Disability Health Options (MnDHO), a capitated Medicaid program.
PARTICIPANTS: Medicaid beneficiaries ages 18 to 64 with physical disabilities
arising from multiple sclerosis, cerebral palsy, spinal cord injury, or brain
injury. INTERVENTIONS: Not applicable. MAIN OUTCOMES MEASURES: Change in
expenditures, rate of return, and utilization. RESULTS: Mean MnDHO monthly
expenditures including care coordination increased by a factor of 1.75 (P<.001)
over the previous expenditures. Increasing age has a multiplier effect on
increased expenditures. Hospitalization rates were unchanged, but the average
cost per admission and average length of stay dropped significantly (P=.017,
P=.032, respectively). For people enrolled at least 3 years, annual reductions in
medical costs more than paid for the added cost of care coordination, but the
savings in Year 3 were about 20% of the savings in the first 2 years.
CONCLUSIONS: Care coordination leads to higher program expenditures for enrollees
with moderate physical impairments who encounter access problems, but has little
impact on enrollees who are already getting 24-hour care. There is some evidence
of adverse selection bias. MnDHO's disability care coordination may not be
financially sustainable over the long term.
CI - Copyright 2010 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS