Project Grant R03HL171441

INVESTIGATING MEDICAID POLICY AND ACCESS TO ASTHMA CARE AND TREATMENT (IMPACT) - PROJECT SUMMARY / ABSTRACT ASTHMA AFFECTS 1 IN 12 U.S. ADULTS AND LEADS TO 1.9 MILLION EMERGENCY DEPARTMENT (ED) VISITS AND 500,000 HOSPITALIZATIONS ANNUALLY. PATIENTS OF LOWER SOCIOECONOMIC STATUS, AS WELL AS MEMBERS OF RACIAL AND ETHNIC MINORITIES, ARE DISPROPORTIONATELY MORE LIKELY TO SUFFER FROM ASTHMA AND EXPERIENCE WORSE HEALTH OUTCOMES. MEDICAID IS THE PRIMARY SOURCE OF HEALTH INSURANCE FOR LOW-INCOME PERSONS. HOWEVER, RATES OF PROVIDER ACCEPTANCE OF MEDICAID INSURANCE REMAIN LOW DUE TO POOR REIMBURSEMENT RATES, RESTRICTING ACCESS TO NEEDED CARE. AT THE SAME TIME, MEDICAID MANAGED CARE PLANS HAVE PROLIFERATED AND NOW ACCOUNT FOR OVER TWO-THIRDS OF MEDICAID ENROLLEES. ONE STRATEGY USED BY MANAGED CARE ORGANIZATIONS TO REDUCE HEALTH COSTS IS TO LIMIT PARTICIPATING PROVIDER NETWORKS TO STEER BENEFICIARIES TO HIGH-VALUE PROVIDERS. WHILE STATE AND FEDERAL POLICY REQUIRE MINIMUM STANDARDS FOR NETWORK ADEQUACY, RECENT EVIDENCE SUGGESTS THAT ACTUAL ACCEPTANCE OF MEDICAID AMONG PROVIDERS MAY BE EVEN LOWER THAN REPORTED. THE EXTENT TO WHICH THESE RESTRICTIVE PROVIDER NETWORKS IMPACT ACCESS TO CARE AMONG MEDICAID BENEFICIARIES WITH ASTHMA AND AFFECT HEALTH OUTCOMES REMAINS UNSTUDIED. WE HAVE ASSEMBLED A MULTI-DISCIPLINARY TEAM WITH EXPERTISE IN ASTHMA OUTCOMES, POLICY EVALUATION, AND CLAIMS ANALYSIS TO EVALUATE MEDICAID PROVIDER NETWORK DENSITY, ACCESS TO PRIMARY AND SPECIALTY CARE, AND ED VISIT AND HOSPITALIZATION RATES AMONG A NATIONAL SAMPLE OF ADULT MEDICAID BENEFICIARIES WITH ASTHMA. WE WILL FIRST CONSTRUCT A CLAIMS-BASED MEASURE OF NETWORK DENSITY FOR EACH MANAGED CARE PLAN BY CALCULATING THE RATIO OF IN-NETWORK PRIMARY CARE PROVIDERS AND SPECIALISTS TO THE NUMBER OF BENEFICIARIES ENROLLED IN EACH MANAGED CARE PLAN (AIM 1). NEXT, WE WILL TEST THE HYPOTHESIS THAT LOWER PROVIDER NETWORK DENSITY IS ASSOCIATED WITH LESS FREQUENT PRIMARY AND SPECIALTY CARE (AIM 2) AND MORE FREQUENT ASTHMA-RELATED ED VISITS AND HOSPITALIZATIONS (AIM 3). THIS WORK BUILDS ON THE PI'S K23 FINDINGS AND WILL SERVE AS CRITICAL PRELIMINARY DATA FOR AN R01 PROPOSAL TO EVALUATE THE IMPACT OF MANAGED CARE AND STATE-LEVEL POLICIES ON ASTHMA OUTCOMES AND HEALTH DISPARITIES, WITH A FOCUS ON ASTHMA PATIENTS IN STRUCTURALLY MARGINALIZED COMMUNITIES. OUR FINDINGS CAN BE USED BY ADVOCATES AND POLICYMAKERS TO ENHANCE STANDARDS FOR NETWORK ADEQUACY AND IMPROVE ACCESS TO CARE AMONG ASTHMA PATIENTS WHO EXPERIENCE HEALTH DISPARITIES.