title: MetroHealth Care Plus: Effects Of A Prepared Safety Net On Quality Of Care In A Medicaid Expansion Population.
abstract: Studies of Medicaid expansion have produced conflicting results about whether the expansion is having a positive impact on health and the cost and efficiency of care delivery. To explore the issue further, we examined MetroHealth Care Plus, a Centers for Medicare and Medicaid Services (CMS) waiver program in Ohio composed of three safety-net organizations that enrolled 28,295 uninsured poor patients in closed-panel care during 2013. All participating organizations used electronic health records and patient-centered medical homes, publicly reported performance in a regional health improvement collaborative, and accepted a budget-neutral cap approved by CMS. We compared changes between 2012 and 2013 in achieving quality standards for diabetes and hypertension among 3,437 MetroHealth Care Plus enrollees to changes among 1,150 patients with the same conditions who remained uninsured in both years. Compared to continuously uninsured patients with diabetes, MetroHealth Care Plus enrollees with diabetes improved significantly more on composite standards of care and intermediate outcomes. Among enrollees with hypertension, blood pressure control improvements were insignificantly larger than those in the continuously uninsured group with hypertension. Across all 28,295 enrollees, 2013 total costs of care were 28.7 percent below the budget cap, providing cause for optimism that a prepared safety net can meet the challenges of Medicaid expansion.
authors.affiliation: Randall D. Cebul (rdc@case.edu) is president of the Better Health Partnership, a professor in the Departments of Medicine and of Epidemiology and Biostatistics at Case Western Reserve University, and director of the Case Western Reserve University Center for Health Care Research and Policy at MetroHealth Medical Center, all in Cleveland, Ohio.
authors.forename: Randall D
authors.initials: RD
authors.lastname: Cebul
authors.affiliation: Thomas E. Love is data director of the Better Heath Partnership and a professor in the Departments of Medicine and of Epidemiology and Biostatistics at Case Western Reserve University and at the Case Western Reserve University Center for Health Care Research and Policy at MetroHealth Medical Center.
authors.forename: Thomas E
authors.initials: TE
authors.lastname: Love
authors.affiliation: Douglas Einstadter is a professor in the Departments of Medicine and of Epidemiology and Biostatistics at Case Western Reserve University and at the Case Western Reserve University Center for Health Care Research and Policy at MetroHealth Medical Center.
authors.forename: Douglas
authors.initials: D
authors.lastname: Einstadter
authors.affiliation: Alice S. Petrulis is a professor in the Department of Medicine at Case Western Reserve University.
authors.forename: Alice S
authors.initials: AS
authors.lastname: Petrulis
authors.affiliation: John R. Corlett was vice president for government relations and community affairs at the MetroHealth System when this research was conducted. He is now president and executive director of the Center for Community Solutions, in Cleveland.
authors.forename: John R
authors.initials: JR
authors.lastname: Corlett
mesh_terms: D000293:Adolescent; D000328:Adult; D003920:Diabetes Mellitus / Q000628:therapy; D057286:Electronic Health Records / Q000592:standards / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D006973:Hypertension / Q000628:therapy; D008297:Male; D008484:Medicaid / Q000458:organization & administration*; D017057:Medically Uninsured / Q000706:statistics & numerical data; D008875:Middle Aged; D009820:Ohio; D011787:Quality of Health Care; D064876:Safety-net Providers / Q000706:statistics & numerical data*; D014481:United States; D055815:Young Adult
keywords: Medicaid; Organization and Delivery of Care; Primary Care; Quality Of Care; Safety-Net Systems