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Comprehensive Care Coordination for Children with Chronic Disease

By October 15, 2019Commentary

Seems like we have started posts with this notion before–comprehensive care management and coordination for patients with chronic diseases is supposed to improve outcomes, right?  Apparently not always as demonstrated in research carried by the Journal of the American Medical Association Network Open, which looked at the effects of such a program on outcomes for children covered by Medicaid with chronic diseases.   (JAMA Article)   The study was conducted in Illinois and used data from May 2014 through April 2017.  Over 6000 children covered by the state’s Medicaid program were randomized to usual care or the comprehensive coordination of care effort.  Primary features of the intervention included enhanced education, social support, mental health and care coordination services.  The children in the study had asthma, diabetes, sickle cell disease, seizure disorders and/or premature birth.  Outcomes included total average annual Medicaid expenditures, average annual ER and inpatient utilization and chronic disease status.  Prior to the initiation of the intervention, average spending was $1733 for the patients who ended up assigned to usual care and $1633 for those who ended up in the care management program.  During the study period, both groups experienced a drop in average annual spending, to $1413 for the usual care group and $1341 for those in the intervention arm.  There was not a significant difference in this trend.  Similarly, in regard to inpatient utilization, both groups showed a drop but there was not a significant difference in the drop between the intervention and usual care groups.  The same result occurred in regard to emergency room use.  It is interesting that spending and utilization declined for both groups, and while it is tempting to suggest that maybe there were spillover effects, it is much more likely that other factors were at work in the health system and the Medicaid program which affected all children covered by Medicaid with chronic diseases.  One such factor likely is that Illinois began mandating use of managed care plans for Medicaid during this time period.  And the authors did not include the extra costs of operating the intensive care management program in their analysis, which likely means that it was definitely not cost-effective.


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