The Effects of Case Management in a Medicaid Managed Care Plan

The purpose of this study is to evaluate whether or not case management by a social worker and nurse can decrease the number of emergency room visits, increase the number of primary care doctor visits, and increase quality of life of people in a Medicaid managed care plan.

This study will assign participants based on Zip Code to one of two conditions: control and experimental. In the control group, participants will receive telephonic assessments at baseline, three months, and six months. These assessments will be conducted by a member of the Medical Center's Department of Geriatrics under the supervision of the Principal Investigator. Participants in the experimental group will receive medical case management provided by a nurse and social worker in the homecare setting including an in-home assessment. Assessments will be conducted at baseline, three months, and six months during routine homecare visits. Dependent variables being measured include: access to primary care physicians, emergent hospitalizations/admissions, articulation of advance directives, and quality of life. Data will be collected through the participants' medical claims and records to analyze the number of emergent hospitalizations/admissions, documentation of advance directives, and number of visits to primary care physicians. To measure participants' quality of life, the Depression Self-Rating Scale and the Clinical Anxiety Scale will be utilized. Data will be compared between and within the groups via statistical analyses. The researcher will conduct pre-post comparisons of utilization and other database-derived outcomes for both groups, comparing the 12 months prior to and up to 20 months following enrollment.

The outcome measure for the number of emergency room visits will be calculated from the medical record counting the number of hospital emergency room visits; for access to primary physicians, the medical record will be reviewed as well.

Inclusion Criteria: participation in a Medicaid managed care plan resident of identified zip codes in Brooklyn, NY frequent hospitalizations and low frequency of primary doctor visits Exclusion Criteria: residents outside the catchment area patients not being managed in a Medicaid managed care plan

Chattopadhyay A, Bindman AB. The contribution of Medicaid managed care to the increasing undercount of Medicaid beneficiaries in the Current Population Survey. Med Care. 2006 Sep;44(9):822-6. doi: 10.1097/01.mlr.0000218835.78953.53.