Addressing Fragmentation in the Health Care of Medicare and Medicaid Beneficiaries

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Patients in the United States routinely receive care from multiple providers who fail to communicate with each other, and this lack of coordination leads to inefficiencies in care delivery. The effectiveness of treatment is especially at risk when care is fragmented—when no single provider accounts for a substantial proportion of the patient’s visits. Previous research has shown that for Medicare beneficiaries, fragmented ambulatory care is associated with significantly higher rates of emergency department visits, more frequent hospital admissions, and greater costs. However, fragmentation in care received by Medicaid beneficiaries has not been well studied. Further, it is unknown whether fragmentation varies between fee‐for‐service and managed care. This project will build on the grantee’s current Commonwealth Fund–supported analysis of a multipayer dataset encompassing a seven‐county region in New York State—work that has so far yielded surprising findings showing that patient care is similarly fragmented in Medicaid managed care and Medicaid fee‐for-service. Using New York Medicare and Medicaid claims data for the period 2008 to 2013, the investigators will measure health care fragmentation for Medicare fee‐for‐service beneficiaries, Medicaid fee‐for‐service and managed care beneficiaries, and dual‐eligible enrollees. The goal is to determine how fragmentation in ambulatory care changes over time and how it varies by insurance product (fee‐for‐service vs. managed care). The team will first examine this variation at the population level, looking at trends in fragmentation over a time frame that includes the expansion of Medicaid managed care. The researchers will then compare the experiences of beneficiaries who switched from fee‐for‐service to managed care to the experiences of beneficiaries who remained consistently in one or the other. Project findings could inform the design of policies to incentivize less fragmentation in care. This work is particularly timely and relevant given that both the federal government and states seek to enroll more beneficiaries in managed care, with the intention that it will to lead better outcomes and more efficient use of services for Medicare and Medicaid enrollees.

Grant Details

Grantee Organization:
Joan and Sanford I. Weill Medical College of Cornell University
Principal Investigator:
Lisa Kern, M.D., M.P.H., FACP
Award Amount:
$225,907.00
Approval Date:
November 8, 2016

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