Our Say Ahhh! audience is certainly
aware of the benefits of implementing continuous coverage, namely, how it can
improve health outcomes for beneficiaries while also decreasing administrative
and utilization costs. As of January 1, 2012, 28 states offer 12-month continuous eligibility in their CHIP programs (23 in Medicaid). Alabama is one of
those states, and is the subject of a study that recently
appeared in “Clinical Pediatricians”. This study focuses on children with chronic asthma in Alabama’s CHIP
program, “ALL Kids,” and furthers the case for the states that haven’t yet chosen
to take up the continuous coverage option.
In order to examine the utilization
of asthma-related care and its associated costs, the researchers identified
CHIP enrollees with persistent asthma who were continuously enrolled in ALL Kids for at least three years between 1998 and 2009. Matching billing
codes for treatment or prescriptions that met the definition of asthma used by
the Healthcare Effectiveness Data and Information Set (HEDIS), 1,954 children
with persistent asthma were identified for the study.
Controlling for age, gender and
calendar year of enrollment, the findings show an overall decline in
utilization of asthma related care in subsequent years of enrollment, when
compared to the first year of enrollment. In addition, costs – which were
adjusted for inflation and included any required CHIP payments – also decreased
when compared between the first and subsequent years.
The particular areas where
utilization of services and medication subsided were hospitalizations,
emergency visits, outpatient visits, and both quick relief and long-term
control prescriptions. The decline in asthma related emergency visits
experienced the most marked improvement, declining seven percentage points
between the first (10%) and second year (3%) and continued to decline to 2% in
the third year. Asthma related hospitalizations also decreased from 6% in the
first year to 2% in the second year, where they remained constant in the third
year. Outpatient visits also
diminished from an average of 1.46 visits a year, to 1.12 in the second year
and less than one in the third (0.94). In terms of medication, those prescribed
for long-term control dwindled from an average of 5.8 in the first year to 4.4
in the third year. Quick relief
prescriptions experienced a smaller decline in utilization from an average of
2.6 prescriptions in the first year to 2.1 in the third year.
So what kind of savings do these
decreases in care utilization amount to?
Total costs for all asthma related care dropped from an average of
$1,395 in the first year, to $1,281 in the second year, and $1,134 in the third year, an average savings of $261 dollars. Inpatient services experienced the
biggest dollar decline in services, saving $207 over three years. In regard to
medications, average costs for long-term control prescriptions had bigger
savings than average costs for quick-relief medications, $115 vs. $14.
Researchers suggest that the
decrease in care utilization, and consequently costs, may be due to families
having regular access to outpatient services which allow them to be better educated
about their asthma, and allow for better self-management of the disease.
This study illustrates the impact
that having access to a usual source of care can have on treating chronic
asthma, which according to the study is one of the most prevalent chronic diseases
experienced by children in the U.S. In addition, it has implications for how
children with other chronic health conditions stand to benefit from access to
continuous care.