Hennepin County.
Hennepin Healthcare and Hennepin Healthcare Research Institute.
Med Care. 2019 Feb;57(2):123-130. doi: 10.1097/MLR.0000000000001024.
The expansion of Medicaid as part of the Affordable Care Act opened new opportunities to provide health coverage to low-income adults who may be involved in other public sectors.
The main objective of this study was to describe cross-sector utilization patterns among urban Medicaid expansion enrollees.
We merged data from 4 public sectors (health care, human services, housing, and criminal justice) for 98,282 Medicaid expansion enrollees in Hennepin County, MN. We fit a latent class model to indicators of cross-sector involvement.
Indicator variables described involvement levels within each sector from March 2011 through December 2014. Demographic and chronic condition indicators were included post hoc to characterize classes.
We found 6 archetypes of cross-sector involvement: The "Low Contact" class (33.9%) had little involvement in any public sector; "Primary Care" (26.3%) had moderate, stable health care utilization; "Health and Human Services" (15.3%) had high rates of health care and cash assistance utilization; "Minimal Criminal History" (11.0%) had less serious criminal justice involvement; "Cross-sector" (7.8%) had elevated emergency department use, involvement in all 4 sectors, and the highest prevalence of behavioral health conditions; "Extensive Criminal History" (5.7%) had serious criminal justice involvement. The 3 most expensive classes (Health and Human Services, Cross-sector, and Extensive Criminal History) had the highest rates of behavioral health conditions. Together, they comprised 29% of enrollees and 70% of total public costs.
Medicaid expansion enrollees with behavioral health conditions deserve focus due to the high cost-reduction potential across public sectors. Cross-sector collaboration is a plausible path to reduce costs and improve outcomes.
《平价医疗法案》（Affordable Care Act）扩大医疗补助计划（Medicaid）的范围，为可能参与其他公共部门的低收入成年人提供健康保险提供了新的机会。
本研究的主要目的是描述城市医疗补助计划扩员参保者的跨部门利用模式。
我们合并了明尼苏达州亨内平县 4 个公共部门（医疗保健、社会服务、住房和刑事司法）的 49828 名医疗补助计划扩员参保者的数据。我们使用潜在类别模型拟合跨部门参与指标。
从 2011 年 3 月至 2014 年 12 月，描述各部门内参与程度的指标变量。人口统计学和慢性疾病指标是在事后加入的，以描述类别。
我们发现了 6 种跨部门参与的模式：“低接触”类（33.9%）在任何公共部门的参与度都较低；“初级保健”类（26.3%）有稳定的中等医疗保健利用率；“卫生和人类服务”类（15.3%）有较高的医疗保健和现金援助利用率；“轻微犯罪史”类（11.0%）犯罪司法参与程度较低；“跨部门”类（7.8%）急诊使用率较高，涉及所有 4 个部门，以及最高的行为健康状况患病率；“广泛犯罪史”类（5.7%）有严重的犯罪司法参与。费用最高的 3 个类别（卫生和人类服务、跨部门和广泛犯罪史）行为健康状况患病率最高。这三个类别共占参保人数的 29%，占公共总费用的 70%。
由于跨公共部门具有降低成本的巨大潜力，因此患有行为健康状况的医疗补助计划扩员参保者值得关注。跨部门合作是降低成本和改善结果的可行途径。
