Long-Term Impact of a Comprehensive Care Coordination Program on Medicaid Expenditures Among Children and Young Adults with Chronic Diseases

OBJECTIVES: Chronic medical conditions are increasing in the population of young people. A comprehensive care program, Coordinated Healthcare for Complex Kids (CHECK), was provided to Medicaid eligible children, adolescents, and young adults with one or more chronic medical condition. The objective of the program was to enhance healthcare and decrease emergency department (ED) and hospitalization expenditures. This study describes the 58-month impact of the CHECK program on Medicaid expenditures, with a usual care (UC) control.

METHODS: Patients enrolled in the CHECK program between June 2014 and October 2019 were included in the analysis. Care coordination claims data provided by the Illinois Department of Healthcare and Family Services were used to measure overall expenditure and expenditure by category (inpatient, outpatient, ED, prescription and other) for each patient. SAS® 9.4 was used to conduct a segmented regression analysis of three time periods related to program implementation: pre-enrollment, grant-funded, and self-funded. A prespecified ordinary least squares regression model was used to obtain trends in expenditures. The model was further adjusted for seasonal effects. The effect of high-cost claims on model results was evaluated in sensitivity analyses.

RESULTS: The analysis included 5,234 CHECK and 2,677 UC patients. Average monthly expenditures for the CHECK group during the three time periods were $343, $315, and $345, respectively. The corresponding UC group expenditures were $228, $151, and $214. Increasing trends in expenditure were observed in both groups after implementation of the CHECK program. Adjusting for autocorrelation and removing outlier claims of over $500,000 did not change model findings.

CONCLUSIONS: The CHECK program did not appear to reduce or increase long-term Medicaid expenditures.