title: Quality of Care for Chronic Conditions Among Disabled Medicaid Enrollees: An Evaluation of a 1915 (b) and (c) Waiver Program.
abstract: OBJECTIVE
  Examining the impact of Medicaid-managed care home-based and community-based service (HCBS) alternatives to institutional care is critical given the recent rapid expansion of these models nationally.
  
  
  OBJECTIVE
  We analyzed the effects of STAR+PLUS, a Texas Medicaid-managed care HCBS waiver program for adults with disabilities on the quality of chronic disease care.
  
  
  METHODS
  We compared quality before and after a mandatory transition of disabled Medicaid enrollees older than 21 years from fee-for-service (FFS) or primary care case management (PCCM) to STAR+PLUS in 28 counties, relative to enrollees in counties remaining in the FFS or PCCM models.
  
  
  METHODS
  Person-level claims and encounter data for 2006-2010 were used to compute adherence to 6 quality measures. With county as the independent sampling unit, we employed a longitudinal linear mixed-model analysis accounting for administrative clustering and geographic and individual factors.
  
  
  RESULTS
  Although quality was similar among programs at baseline, STAR+PLUS enrollees experienced large and sustained improvements in use of β-blockers after discharge for heart attack (49% vs. 81% adherence posttransition; P<0.01) and appropriate use of systemic corticosteroids and bronchodilators after a chronic obstructive pulmonary disease event (39% vs. 68% adherence posttransition; P<0.0001) compared with FFS/PCCM enrollees. No statistically significant effects were identified for quality measures for asthma, diabetes, or cardiovascular disease.
  
  
  CONCLUSIONS
  In 1 large Medicaid-managed care HCBS program, the quality of chronic disease care linked to acute events improved while that provided during routine encounters appeared unaffected.
authors.affiliation: Departments of *Health Outcomes and Policy †Epidemiology, University of Florida, Gainesville, FL ‡Aetna Foundation, Hartford, CT.
authors.forename: Martin P
authors.initials: MP
authors.lastname: Wegman
authors.forename: Jill B
authors.initials: JB
authors.lastname: Herndon
authors.forename: Keith E
authors.initials: KE
authors.lastname: Muller
authors.forename: Garth N
authors.initials: GN
authors.lastname: Graham
authors.forename: W Bruce
authors.initials: WB
authors.lastname: Vogel
authors.forename: Kimberly H
authors.initials: KH
authors.lastname: Case
authors.forename: Jason A
authors.initials: JA
authors.lastname: Lee
authors.forename: Matthew F
authors.initials: MF
authors.lastname: Van Voorhis
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Shenkman
mesh_terms: D000328:Adult; D019090:Case Management; D002908:Chronic Disease / Q000628:therapy; D006233:Persons with Disabilities; D005260:Female; D006302:Health Services Research; D006801:Humans; D008297:Male; D008329:Managed Care Programs / Q000191:economics*; D008484:Medicaid / Q000191:economics*; D008875:Middle Aged; D011320:Primary Health Care; D015397:Program Evaluation; D011787:Quality of Health Care; D013781:Texas; D014481:United States