Impact of a statewide Medicaid managed care system on healthcare utilization and outcomes for people living with HIV.
BACKGROUND
Medicaid managed care (MMC) systems provide insurance for many persons living with HIV and AIDS (PLWH). This study sought to assess the impact of a statewide MMC system (TennCare) on healthcare utilization and outcomes for PLWH.


METHODS
A retrospective longitudinal analysis of trends in population characteristics was performed. The study population included all Tennessee PLWH identified by State Health Department, enrolled for 1 year or longer in Medicaid (1992-1993) or TennCare (1994-1997). Main outcome measures included health care utilization, incidence of opportunistic infections, and mortality.


RESULTS
From 1992 to 1997, the following decreased: average number of hospitalizations for HIV (0.72 to 0.37) and AIDS (1.27 to 0.52); emergency visits for HIV (1.70 to 1.12) and AIDS (1.65 to 1.02); outpatient visits for HIV (5.94 to 5.00) and AIDS (8.37 to 7.35), percentage of persons diagnosed with Pneumocystis carinii pneumonia for AIDS (10% to 6%) and percentage of persons diagnosed with community-acquired pneumonia for HIV (14% to 9%) and AIDS (27% to 12%), annual incidence of AIDS in the HIV population (33% to 10%), and annual mortality for HIV (3% to 1%) and AIDS (16% to 3%). The average number of antiretroviral medication prescriptions filled increased for HIV (1.27 to 2.45) and AIDS (1.31 to 3.34).


CONCLUSIONS
This study documents improvements in utilization patterns, morbidity, and mortality in a statewide MMC system. These findings suggest that MMC patients are benefiting from recent advances in therapy.
Bailey
James E
JE
Department of Medicine, University of Tennessee Health Science Center, Memphis, Tennessee 38105, USA. jeb@utmem.edu
Van Brunt
David L
DL
Somes
Grant W
GW
Dorko
Craig S
CS
Wan
Jim Y
JY
D000328:Adult; D005260:Female; D015658:HIV Infections / Q000628:therapy*; D006296:Health Services / Q000706:statistics & numerical data*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008329:Managed Care Programs / Q000458:organization & administration*; D008484:Medicaid / Q000458:organization & administration*; D017063:Outcome Assessment, Health Care; D012189:Retrospective Studies; D013221:State Health Plans / Q000458:organization & administration*; D013714:Tennessee; D014481:United States