Medicaid and Public Health: Second Edition

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Division of Hematology and Oncology, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL 32610, USA
Interests: health policy; epidemiology; health services research; oncology; leukemia; myelodysplastic syndromes
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Special Issue Information

Dear Colleagues,

In this Special Issue, we present reports on Medicaid. This US-based healthcare program was originally instituted in the 1960s for people with low-paid jobs, mothers, babies, children, alternately abled people struggling to find or keep gainful employment, and seniors with meagre resources. This federal program empowers states to administer healthcare coverage to these disadvantaged populations. Since then, healthcare, health, and society have changed. To keep with the times and control costs, the federal government and states have adapted Medicaid in many ways. This Special Issue is intended to house reports of these adaptations and their outcomes.

A lot of what Medicaid pays for is preventable problems. Heart disease and cancers are preventable by not using tobacco. Vaccinations prevent infections and cancers. Clear communication between people and their healthcare providers prevents emergency room visits, hospitalizations, and re-hospitalizations. In this Special Issue, we will report on innovations in prevention for both short-term improvements in care but also long-term improvements. Evidence from this Special Issue is meant to help state Medicaid programs as they research methods for improving their programs.

A common complaint about Medicaid is its high cost. However, its high cost is a direct consequence of social inequities in the US. The basic needs for a good life, such as food, housing, security, and supportive relationships, are variably distributed in the US and sometimes withheld based on the color of one’s skin, spelling of their name, gender, and other types of discrimination. These upstream inequities result in downstream health disparities. The deeper pressure to improve Medicaid is achieving social justice before Medicaid is even needed. This Special Issue will publish manuscripts showing the need and mechanisms of addressing social inequities. These publications will urge Medicaid programs to reach out to other departments for new and stronger partnerships.

Medicaid is critical to states achieving wellbeing for all their people. Because of Medicaid’s eligibility requirements, by definition, it is a healthcare delivery system directly impacted by social determinants of health. Nearly all people depending on Medicaid experience financial hardship, which is causally related to other physical deprivations, such as depression and anxiety. Articles of interest in this Special Issue will be new healthcare delivery innovations that achieve health equity by also addressing an individual’s social and environmental surroundings. These innovations will assist health service researchers looking for inspiration and implementation scientists in search of methods for deployment.

Because Medicaid is dependent on federal and state government cooperation, this program is often politically charged. Thus, this Special Issue is also meant to house Perspective pieces and Editorials that are well referenced.

Ultimately, we strive for a society where all people are healthy, happy, and secure. This Special Issue is meant to demonstrate our progress toward that vision.

Yours in improving health and healthcare,

Prof. Dr. Christopher R. Cogle
Guest Editor

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Keywords

  • medicaid
  • health services 
  • healthcare delivery
  • health policy
  • population health
  • public health
  • health equity
  • health disparities

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Published Papers (5 papers)

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Research

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10 pages, 500 KiB  
Article
Leveraging Quality Improvement and Shared Learning to Improve Infant Well-Child Visit Rates in Texas
by Emily Stauffer Rocha, Susana Beatriz Peñate and Ryan D. Van Ramshorst
Healthcare 2024, 12(19), 1965; https://doi.org/10.3390/healthcare12191965 - 2 Oct 2024
Viewed by 487
Abstract
Texas Medicaid improved infant well-child visit rates by participating in a national learning collaborative. The two-year program encouraged creativity and innovation in care for Medicaid recipients through partnerships with managed care organizations (MCOs). The MCO projects discovered valuable practices in member outreach and [...] Read more.
Texas Medicaid improved infant well-child visit rates by participating in a national learning collaborative. The two-year program encouraged creativity and innovation in care for Medicaid recipients through partnerships with managed care organizations (MCOs). The MCO projects discovered valuable practices in member outreach and were disseminated in shared learning experiences. At the completion of the learning collaborative, Texas Medicaid surveyed the MCO participants to assess the impact of their projects on Medicaid beneficiaries in Texas as well as the quality improvement project format. Collectively, the MCOs raised the infant well-child visit rate year-over-year. All of the partner MCOs stated they plan to continue focused work on improving infant well-child visit rates after the learning collaborative. Full article
(This article belongs to the Special Issue Medicaid and Public Health: Second Edition)
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9 pages, 803 KiB  
Article
Influence of Health Insurance Coverage on the Survival Rate for Primary Total Knee Arthroplasty: Minimum 5-Year Follow-Up Analysis
by Jae-Sung Seo, Jung-Kwon Bae, Seong-Kee Shin, Hyung-Gon Ryu, Kyu Jin Kim and Seung Yeon Cho
Healthcare 2024, 12(16), 1601; https://doi.org/10.3390/healthcare12161601 - 12 Aug 2024
Viewed by 795
Abstract
This study investigated whether differences in survival rates and clinical outcomes exist in patients undergoing TKA by insurance type: National Health Insurance (NHI) vs. Medical Aid Program (MAP). This study conducted a retrospective analysis of 762 TKAs (NHI, n = 505; MAP, n [...] Read more.
This study investigated whether differences in survival rates and clinical outcomes exist in patients undergoing TKA by insurance type: National Health Insurance (NHI) vs. Medical Aid Program (MAP). This study conducted a retrospective analysis of 762 TKAs (NHI, n = 505; MAP, n = 257) with a mean follow-up of 8.4 ± 1.8 years. Patient-reported outcomes (PROMs) were evaluated using the American Knee Society’s (AKS) score at the final follow-up. The survival rate of each group was analyzed using Kaplan–Meier survival analysis. Any postoperative complications and readmissions within 90 days of discharge were recorded and compared between the groups. There were no between-group differences in pre- to postoperative improvement in AKS scores. The estimated 10-year survival rates were 98.5% in the NHI group and 96.9% in the MAP group, respectively, with no significant differences (p = 0.48). However, the length of hospital stay (LOS) was significantly longer in the MAP group than in the NHI group (13.4 days vs. 13.1 days, p = 0.03), and the transfer rate to other departments was significantly higher in the MAP group than in the NHI group (3.9% vs. 1.4%, p = 0.04). Readmission rates for orthopedic complications for 90 days were 3.0% in the NHI group and 3.5% in the MAP group, respectively (p = 0.67). Patients’ insurance type showed similar survival rates and clinical outcomes to those of primary TKA at a mean follow-up of 8.4 years, but the LOS and rate of transfer to other departments during hospitalization were influenced by insurance type. Full article
(This article belongs to the Special Issue Medicaid and Public Health: Second Edition)
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14 pages, 435 KiB  
Article
Practice Site Heterogeneity within and between Medicaid Accountable Care Organizations
by Zachary Dyer, Matthew Alcusky, Jay Himmelstein, Arlene Ash and Michaela Kerrissey
Healthcare 2024, 12(2), 266; https://doi.org/10.3390/healthcare12020266 - 20 Jan 2024
Cited by 1 | Viewed by 978
Abstract
The existing literature has considered accountable care organizations (ACOs) as whole entities, neglecting potentially important variations in the characteristics and experiences of the individual practice sites that comprise them. In this observational cross-sectional study, our aim is to characterize the experience, capacity, and [...] Read more.
The existing literature has considered accountable care organizations (ACOs) as whole entities, neglecting potentially important variations in the characteristics and experiences of the individual practice sites that comprise them. In this observational cross-sectional study, our aim is to characterize the experience, capacity, and process heterogeneity at the practice site level within and between Medicaid ACOs, drawing on the Massachusetts Medicaid and Children’s Health Insurance Program (MassHealth), which launched an ACO reform effort in 2018. We used a 2019 survey of a representative sample of administrators from practice sites participating in Medicaid ACOs in Massachusetts (n = 225). We quantified the clustering of responses by practice site within all 17 Medicaid ACOs in Massachusetts for measures of process change, previous experience with alternative payment models, and changes in the practices’ ability to deliver high-quality care. Using multilevel logistic models, we calculated median odds ratios (MORs) and intraclass correlation coefficients (ICCs) to quantify the variation within and between ACOs for each measure. We found greater heterogeneity within the ACOs than between them for all measures, regardless of practice site and ACO characteristics (all ICCs ≤ 0.26). Our research indicates diverse experience with, and capacity for, implementing ACO initiatives across practice sites in Medicaid ACOs. Future research and program design should account for characteristics of practice sites within ACOs. Full article
(This article belongs to the Special Issue Medicaid and Public Health: Second Edition)
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14 pages, 534 KiB  
Article
Relationship between Depression and Anxiety during Pregnancy, Delivery-Related Outcomes, and Healthcare Utilization in Michigan Medicaid, 2012–2021
by Kara Zivin, Xiaosong Zhang, Anca Tilea, Sarah J. Clark and Stephanie V. Hall
Healthcare 2023, 11(22), 2921; https://doi.org/10.3390/healthcare11222921 - 7 Nov 2023
Viewed by 1357
Abstract
To evaluate associations between depression and/or anxiety disorders during pregnancy (DAP), delivery-related outcomes, and healthcare utilization among individuals with Michigan Medicaid-funded deliveries. We conducted a retrospective delivery-level analysis comparing delivery-related outcomes and healthcare utilization among individuals with and without DAP between January 2012 [...] Read more.
To evaluate associations between depression and/or anxiety disorders during pregnancy (DAP), delivery-related outcomes, and healthcare utilization among individuals with Michigan Medicaid-funded deliveries. We conducted a retrospective delivery-level analysis comparing delivery-related outcomes and healthcare utilization among individuals with and without DAP between January 2012 and September 2021. We used generalized estimating equation models assessing cesarean and preterm delivery; 30-day readmission after delivery; severe maternal morbidity within 42 days of delivery; and ambulatory, inpatient, emergency department or observation (ED), psychotherapy, or substance use disorders (SUD) visits during pregnancy. We adjusted models for age, race/ethnicity, urbanicity, federal poverty level, and obstetric comorbidities. Among 170,002 Michigan Medicaid enrollees with 218,890 deliveries, 29,665 (13.6%) had diagnoses of DAP. Compared to those without DAP, individuals with DAP were more often White, rural dwelling, had lower income, and had more comorbidities. In adjusted models, deliveries with DAP had higher odds of cesarean and preterm delivery OR = 1.02, 95% CI: [1.00, 1.05] and OR = 1.15, 95% CI: [1.11, 1.19] respectively), readmission within 30 days postpartum (OR = 1.14, 95% CI: [1.07, 1.22]), SMM within 42 days (OR = 1.27, 95% CI: [1.18, 1.38]), and utilization compared to those without DAP diagnoses (ambulatory: OR = 7.75, 95% CI: [6.75, 8.88], inpatient: OR = 1.13, 95% CI: [1.11, 1.15], ED: OR = 1.86, 95% CI: [1.80, 1.92], psychotherapy: OR = 172.8, 95% CI: [160.10, 186.58], and SUD: OR = 5.6, 95% CI: [5.37, 5.85]). Among delivering individuals in Michigan Medicaid, DAP had significant associations with adverse delivery-related outcomes and greater healthcare use. Early detection and intervention to address mental illness during pregnancy may help mitigate burdens of these complex yet treatable disorders. Full article
(This article belongs to the Special Issue Medicaid and Public Health: Second Edition)
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Other

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7 pages, 226 KiB  
Brief Report
Inappropriate Prescribing of Antibiotics to Pediatric Patients Receiving Medicaid: Comparison of High-Volume and Non-High-Volume Antibiotic Prescribers—Kentucky, 2019
by Bethany A. Wattles, Michael J. Smith, Yana Feygin, Kahir Jawad, Andrea Flinchum, Brittany Corley and Kevin B. Spicer
Healthcare 2023, 11(16), 2307; https://doi.org/10.3390/healthcare11162307 - 16 Aug 2023
Cited by 1 | Viewed by 1059
Abstract
Inappropriate antibiotic prescribing to pediatric Medicaid patients was compared among high-volume and non-high-volume prescribers. High-volume prescribers had a higher percentage of inappropriate prescriptions than non-high-volume prescribers (17.2% versus 15.8%, p = 0.005). Targeting high-volume prescribers for stewardship efforts is a practical approach to [...] Read more.
Inappropriate antibiotic prescribing to pediatric Medicaid patients was compared among high-volume and non-high-volume prescribers. High-volume prescribers had a higher percentage of inappropriate prescriptions than non-high-volume prescribers (17.2% versus 15.8%, p = 0.005). Targeting high-volume prescribers for stewardship efforts is a practical approach to reducing outpatient antibiotic prescribing that also captures inappropriate use. Full article
(This article belongs to the Special Issue Medicaid and Public Health: Second Edition)

Planned Papers

The below list represents only planned manuscripts. Some of these manuscripts have not been received by the Editorial Office yet. Papers submitted to MDPI journals are subject to peer-review.

Title: Overcoming Barriers to Participation in Tobacco Cessation Programs among Medicaid Managed Care Enrollees

Abstract: Background/Objectives: Tobacco use remains a significant public health issue, particularly among individuals with low incomes, including Medicaid recipients who often face multiple barriers to quitting.  This study aimed to identify barriers, from the perspective of Medicaid managed care organizations (MCOs), influencing Medicaid recipient participation in tobacco cessation programs.  Methods: Focus group interviews were conducted with Florida Medicaid MCOs to elicit processes for case identification, outreach, referral, program participation, and incentives.  Answers were synthesized into themes.  Results: Medicaid recipients were primarily identified through nicotine dependency claim codes or Health Risk Assessments (HRAs).  Individuals were referred to state and local community tobacco cessation programs through text messaging and outreach by MCO case managers.  The MCOs identified as barriers: primary care physicians (PCPs) with limited knowledge about cessation programs and pharmacologic treatments for nicotine dependence, low availability of health coaches, long wait times for entry into cessation programs, weak coordination between MCOs and cessation programs, and insufficient incentives to individuals for program participation.  Suggested strategies to overcome barriers were continuing medical education (CME) for PCPs about tobacco cessation programs and prescription therapies, increasing the training of health coaches, more investment in quit lines, increasing data sharing between MCOs and cessation programs, and increasing incentives for individuals.  Conclusion: These findings highlight the importance of engaging MCOs in discussions about policy and program improvements, as their insights can drive meaningful changes in how tobacco cessation and other preventive health programs are structured and implemented.  Targeted interventions are needed to enhance tobacco cessation program participation among Medicaid recipients.

Keywords: tobacco cessation; Medicaid; managed care

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