Individuals with intellectual and developmental disorders (IDD) face complex health problems and experiencesubstantially higher rates of chronic conditions and behavioral health (BH) problems. They also face uniquebarriers to high quality care such as inadequate knowledge among health professionals of the way biological,psychological, and social factors interact to determine overall health for people with IDD and communicationchallenges between patients and providers. There is evidence of significant unmet needs in physical andmental health care that disproportionately impact racial and ethnic minorities, including poorer health, as wellas lower rates of recommended preventive screenings and vaccinations, dental services, and social services.Compounding these issues is the high reliance among the IDD population on insurance coverage throughMedicaid, which provides much lower reimbursement than other payers. Although prior research providessome evidence of differences across racial and ethnic groups, it does not examine the impact and magnitudeof specific system and environmental factors that may give rise to such disparities. Current evidence is oflimited value for health policy formulation or system intervention design partly due to limitations in datasets andstudy designs that limit generalizability and do not allow comprehensive examination of care, utilization andoutcomes. This project will identify patient, provider, and system-level factors that drive racial/ethnic disparitiesin adequacy of ambulatory medical and BH services among Medicaid-enrolled adults with intellectual anddevelopmental disorders. It will specifically focus on IDD program services and their effect on patient overallhealth and wellbeing. We will use multi-year Medicaid claims data to analyze healthcare utilization andoutcomes for individuals with IDD who reside in Intermediate Care Facilities, in the community with eligibility forMedicaid-funded IDD program services, and in the community but not eligible for such services. Understandingvariations in system-level factors that contribute to gaps in care will help identify and address underlying racialand ethnic disparities in care among individuals with IDD. Analyses by the study team of service use andexpenditures for New Jersey Medicaid beneficiaries show that patients with IDD are among the highest costbeneficiaries and make greater use of inpatient hospital and emergency department care. We will address thisissue using a range of guideline-based quality metrics for IDD patients in Medicaid, including measures ofpreventive service use, inpatient and outpatient health outcomes that reflect coordination and continuity ofcare, follow up rates, and integration between physical and behavioral health care. Study results can provideimportant policy guidance relating to performance metrics or incentives within Medicaid managed carecontracts; lead to guidelines for health professionals offering specific services; promote patient and familyeducation among minority communities; and inform advocacy organizations about issues such as preventivecare and recommended timelines for receiving procedures.
|Effective start/end date||5/1/18 → 4/30/20|
- Agency for Healthcare Research and Quality (AHRQ)