Strategies to Reduce Medicaid Spending: Findings from a Literature Review
Issue Brief
Powell V, Saloner B, Sabik LM. Cost sharing in Medicaid: Assumptions, evidence, and future directions. Med. Care Res. Rev. 2016;73(4):383-409.
Snyder L, Rudowitz R. Premiums and cost-sharing in Medicaid: A review of research findings. Kaiser Commission on Medicaid and the Uninsured; 2013. https://www.kff.org/wp-content/uploads/2013/02/8417-premiums-and-cost-sharing-in-medicaid.pdf
MACPAC. The effect of premiums and cost sharing on access and outcomes for low-income children. [Issue Brief]. 2015; https://www.macpac.gov/wp-content/uploads/2015/07/Effect-of-Cost-Sharing-on-Low-Income-Children.pdf.
Dague L. The effect of Medicaid premiums on enrollment: A regression discontinuity approach. J. Health Econ. 2014;37:1-12. doi: 10.1016/j.jhealeco.2014.05.001
Wright BJ, Carlson MJ, Allen H, Holmgren AL, Rustvold DL. Raising premiums and other costs for Oregon health plan enrollees drove many to drop out. Health Aff. (Millwood). 2010;29(12):2311-2316. doi: 10.1377/hlthaff.2010.0211
Kenney G, Allison RA, Costich JF, Marton J, McFeeters J. Effects of premium increases on enrollment in SCHIP: findings from three states. Inquiry. 2006;43(4):378-392. doi: 10.5034/inquiryjrnl_43.4.378
Herndon JB, Vogel WB, Bucciarelli RL, Shenkman EA. The effect of premium changes on SCHIP enrollment duration. Health Serv. Res. 2008;43(2):458-477. doi: 10.1111/j.1475-6773.2007.00777.x
Dague L. The effect of Medicaid premiums on enrollment: A regression discontinuity approach. J. Health Econ. 2014;37:1-12. doi: 10.1016/j.jhealeco.2014.05.001
MACPAC. The effect of premiums and cost sharing on access and outcomes for low-income children. [Issue Brief]. 2015; https://www.macpac.gov/wp-content/uploads/2015/07/Effect-of-Cost-Sharing-on-Low-Income-Children.pdf.
Snyder L, Rudowitz R. Premiums and cost-sharing in Medicaid: A review of research findings. Kaiser Commission on Medicaid and the Uninsured; 2013. https://www.kff.org/wp-content/uploads/2013/02/8417-premiums-and-cost-sharing-in-medicaid.pdf
Wright BJ, Carlson MJ, Allen H, Holmgren AL, Rustvold DL. Raising premiums and other costs for
Oregon health plan enrollees drove many to drop out. Health Aff. (Millwood).
2010;29(12):2311-2316. doi: 10.1377/hlthaff.2010.0211
Manning WG, Newhouse JP, Duan N, Keeler EB, Leibowitz A, Marquis MS. Health insurance and the
demand for medical care: Evidence from a randomized experiment. Am. Econ. Rev.
1987;77(3):251-277.
Powell V, Saloner B, Sabik LM. Cost sharing in Medicaid: Assumptions, evidence, and future directions.
Med. Care Res. Rev. 2016;73(4):383-409.
Snyder L, Rudowitz R. Premiums and cost-sharing in Medicaid: A review of research findings. Kaiser
Commission on Medicaid and the Uninsured; 2013.
https://www.kff.org/wp-content/uploads/2013/02/8417-premiums-and-cost-sharing-in-medicaid.pdf
MACPAC. The effect of premiums and cost sharing on access and outcomes for low-income children.
[Issue Brief]. 2015; https://www.macpac.gov/wp-content/uploads/2015/07/Effect-of-Cost-Sharing-on-Low-Income-Children.pdf
Wallace NT, McConnell KJ, Gallia CA, Smith JA. How effective are copayments in reducing expenditures for low-income adult Medicaid beneficiaries? Experience from the Oregon health plan. Health Serv. Res. 2008;43(2):515-530. doi: 10.1111/j.1475-6773.2007.00824.x
Subramanian S. Impact of Medicaid copayments on patients with cancer: Lessons for Medicaid expansion under health reform. Med. Care Res. Rev. 2011;49(9):842-847. doi: 10.1097/MLR.0b013e31821b34db
Wallace NT, McConnell KJ, Gallia CA, Smith JA. How effective are copayments in reducing expenditures for low-income adult Medicaid beneficiaries? Experience from the Oregon health plan. Health Serv. Res. 2008;43(2):515-530. doi: 10.1111/j.1475-6773.2007.00824.x
Snyder L, Rudowitz R. Premiums and cost-sharing in Medicaid: A review of research findings. Kaiser Commission on Medicaid and the Uninsured; 2013. https://www.kff.org/wp-content/uploads/2013/02/8417-premiums-and-cost-sharing-in-medicaid.pdf
State examples include California, Connecticut, Florida, Hawaii, Indiana, Iowa, Kentucky, Michigan,
Minnesota, Montana, New Mexico, Nevada, New Hampshire, New York, Texas, Wisconsin, and West Virginia.
MACPAC. The use of healthy behavior incentives in Medicaid. 2016; https://www.macpac.gov/wp-content/uploads/2016/08/The-Use-of-Healthy-Behavior-Incentives-in-Medicaid.pdf.
MACPAC. The use of healthy behavior incentives in Medicaid. 2016; https://www.macpac.gov/wp-content/uploads/2016/08/The-Use-of-Healthy-Behavior-Incentives-in-Medicaid.pdf.
Blumenthal KJ, Saulsgiver KA, Norton L, et al. Medicaid incentive programs to encourage healthy behavior show mixed results to date and should be studied and improved. Health Aff. (Millwood). 2013;32(3):497-507. doi: 10.1377/hlthaff.2012.0431
Kane RL, Johnson PE, Town RJ, Butler M. A structured review of the effect of economic incentives on consumers' preventive behavior. Am. J. Prev. Med. 2004;27(4):327-352. doi: 10.1016/j.amepre.2004.07.002
Blumenthal KJ, Saulsgiver KA, Norton L, et al. Medicaid incentive programs to encourage healthy behavior show mixed results to date and should be studied and improved. Health Aff. (Millwood). 2013;32(3):497-507. doi: 10.1377/hlthaff.2012.0431
Lewin Group, Inc. Indiana Healthy Indiana Plan 2.0: Interim evaluation report. 2016. https://www.medicaid.gov/medicaid-chip-program-information/by-topics/waivers/1115/downloads/in/healthy-indiana-plan-2/in-healthy-indiana-plan-support-20-interim-evl-rpt-07062016.pdf
U.S. Department of Health and Human Services. Second report to Congress: Medicaid incentives for
prevention of chronic diseases evaluation. 2016. https://innovation.cms.gov/Files/reports/mipcd-secondrtc.pdf
U.S. Department of Health and Human Services. Second report to Congress: Medicaid incentives for prevention of chronic diseases evaluation. 2016. https://innovation.cms.gov/Files/reports/mipcd-secondrtc.pdf
Centers for Medicare & Medicaid Services. Improving care for Medicaid beneficiaries with complex care needs and high costs. Baltimore, MD: Centers for Medicare & Medicaid Services; 2017. https://www.medicaid.gov/state-resource-center/innovation-accelerator-program/beneficiaries-with-complex-needs/beneficiaries-with-complex-needs.html
Mann C. Targeting Medicaid super-utilizers to decrease costs and improve quality [Internet]. Baltimore, MD: Centers for Medicare and Medicaid Services. CMCS Informational Bulletin; 2013.
Robert Wood Johnson Foundation. Better care for super-utilizers. 2017. http://www.rwjf.org/en/library/collections/super-utilizers.html
Williams BC. Limited effects of care management for high utilizers on total healthcare costs. Am. J. Manag. Care. 2015;21(4):e244-246.
Williams BC. Limited effects of care management for high utilizers on total healthcare costs. Am. J. Manag. Care. 2015;21(4):e244-246.
Raven MC, Kushel M, Ko MJ, Penko J, Bindman AB. The effectiveness of emergency department visit reduction programs: A systematic review. Ann. Emerg. Med. 2016;68(4):467-483 e415. doi: 10.1016/j.annemergmed.2016.04.015
Williams BC. Limited effects of care management for high utilizers on total healthcare costs. Am. J. Manag. Care. 2015;21(4):e244-246.
Hong CS, Siegel AL, Ferris TG. Caring for high-need, high-cost patients: what makes for a successful
care management program. Issue Brief (Commonw Fund). 2014;19(1):9.
McCarthy D, Ryan J, Klein S. Models of care for high-need, high-cost patients: an evidence synthesis. Issue Brief (Commonw Fund). 2015;31:1-19.
Bodenheimer T. Strategies to reduce costs and improve care for high-utilizing Medicaid patients:
reflections on pioneering programs. 2013.
Raven MC, Kushel M, Ko MJ, Penko J, Bindman AB. The effectiveness of emergency department visit reduction programs: A systematic review. Ann. Emerg. Med. 2016;68(4):467-483 e415. doi: 10.1016/j.annemergmed.2016.04.015
Hong CS, Siegel AL, Ferris TG. Caring for high-need, high-cost patients: what makes for a successful care management program. Issue Brief (Commonw Fund). 2014;19(1):9.
Bodenheimer T. Strategies to reduce costs and improve care for high-utilizing Medicaid patients: reflections on pioneering programs. 2013.
Xing J, Goehring C, Mancuso D. Care coordination program for Washington State Medicaid enrollees
reduced inpatient hospital costs. Health Aff. (Millwood). 2015;34(4):653-661. doi:
10.1377/hlthaff.2014.0655
Bell J, Mancuso D, Krupski T. A randomized controlled trial of King County Care Partners’ Rethinking
Care Intervention: health and social outcomes up to two years post-randomization. 2012. http://www.chcs.org/resource/randomized-controlled-trial-of-king-county-care-partners-rethinking-care-intervention-health-and-social-outcomes-up-to-two-years-post-randomization/
Kim SE, Michalopoulos C, Kwong RM, Warren A, Manno MS. Telephone care management's effectiveness in coordinating care for Medicaid beneficiaries in managed care: A randomized controlled study. Health Serv. Res. 2013;48(5):1730-1749. doi: 10.1111/1475-6773.12060
Peikes D, Chen A, Schore J, Brown R. Effects of care coordination on hospitalization, quality of care,
and health care expenditures among Medicare beneficiaries: 15 randomized trials. JAMA. 2009;301(6):603-618. doi: 10.1001/jama.2009.126
Peikes D, Chen A, Schore J, Brown R. Effects of care coordination on hospitalization, quality of care,
and health care expenditures among Medicare beneficiaries: 15 randomized trials. JAMA. 2009;301(6):603-618. doi: 10.1001/jama.2009.126
Cohen A. SoonerCare Health Management program evaluation. Oklahoma Health Care Authority. Prepared for State of Oklahoma; 2013.
Bell J, Mancuso D, Krupski T. A randomized controlled trial of King County Care Partners’ Rethinking
Care Intervention: health and social outcomes up to two years post-randomization. 2012. http://www.chcs.org/resource/randomized-controlled-trial-of-king-county-care-partners-rethinking-care-intervention-health-and-social-outcomes-up-to-two-years-post-randomization/
Cohen A. SoonerCare Health Management program evaluation. Oklahoma Health Care Authority. Prepared for State of Oklahoma; 2013.
Xing J, Goehring C, Mancuso D. Care coordination program for Washington State Medicaid enrollees reduced inpatient hospital costs. Health Aff. (Millwood). 2015;34(4):653-661. doi: 10.1377/hlthaff.2014.0655
Cohen A. SoonerCare Health Management program evaluation. Oklahoma Health Care Authority. Prepared for State of Oklahoma; 2013.
Peikes D, Chen A, Schore J, Brown R. Effects of care coordination on hospitalization, quality of care,
and health care expenditures among Medicare beneficiaries: 15 randomized trials. JAMA. 2009;301(6):603-618. doi: 10.1001/jama.2009.126
Burt M, Wilkins C, Locke G. Medicaid and permanent supportive housing for chronically homeless individuals: Emerging practices from the field. 2014; https://aspe.hhs.gov/system/files/pdf/77116/EmergPrac.pdf.
Raven MC, Kushel M, Ko MJ, Penko J, Bindman AB. The effectiveness of emergency department visit reduction programs: A systematic review. Ann. Emerg. Med. 2016;68(4):467-483 e415. doi: 10.1016/j.annemergmed.2016.04.015
Bodenheimer T. Strategies to reduce costs and improve care for high-utilizing Medicaid patients: reflections on pioneering programs. 2013.
Wright BJ, Vartanian KB, Li HF, Royal N, Matson JK. Formerly homeless people had lower overall health care expenditures after moving into supportive housing. Health Aff. (Millwood). 2016;35(1):20-27. doi: 10.1377/hlthaff.2015.0393
Cassidy A. Medicaid and permanent supportive housing. Medicaid offers opportunities to address supportive housing needs, but challenges remain. Health Affairs/Robert Wood Johnson Foundation Health Policy Brief; 2016, October 14. http://healthaffairs.org/healthpolicybriefs/brief_pdfs/healthpolicybrief_164.pdf
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Takach M. About half of the states are implementing patient-centered medical homes for their Medicaid populations. Health Aff. (Millwood). 2012;31(11):2432-2440. doi: 10.1377/hlthaff.2012.0447
Cole ES, Campbell C, Diana ML, Webber L, Culbertson R. Patient-centered medical homes in Louisiana had minimal impact on Medicaid population's use of acute care and costs. Health Aff. (Millwood). 2015;34(1):87-94. doi: 10.1377/hlthaff.2014.0582
Shane DM, Nguyen-Hoang P, Bentler SE, Damiano PC, Momany ET. Medicaid health home reducing costs and reliance on emergency department: evidence from Iowa. Med. Care Res. Rev. 2016;54(8):752-757. doi: 10.1097/MLR.0000000000000555
Cole ES, Campbell C, Diana ML, Webber L, Culbertson R. Patient-centered medical homes in Louisiana
had minimal impact on Medicaid population's use of acute care and costs. Health Aff.
(Millwood). 2015;34(1):87-94. doi: 10.1377/hlthaff.2014.0582
Shane DM, Nguyen-Hoang P, Bentler SE, Damiano PC, Momany ET. Medicaid health home reducing costs and reliance on emergency department: evidence from Iowa. Med. Care Res. Rev. 2016;54(8):752-757. doi: 10.1097/MLR.0000000000000555
Reid RJ, Coleman K, Johnson EA, et al. The Group Health medical home at year two: Cost savings,
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Dale SB, Ghosh A, Peikes DN, et al. Two-year costs and quality in the comprehensive primary care initiative. N. Engl. J. Med. 2016;374(24):2345-2356. doi: 10.1056/NEJMsa1414953
Jones C, Finison K, McGraves-Lloyd K, et al. Vermont's community-oriented all-payer medical home model reduces expenditures and utilization while delivering high-quality care. Popul. Health Manag. 2016;19(3):196-205. doi: 10.1089/pop.2015.0055
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Maeng DD, Khan N, Tomcavage J, Graf TR, Davis DE, Steele GD. Reduced acute inpatient care was largest savings component of Geisinger Health System's patient-centered medical home. Health Aff. (Millwood). 2015;34(4):636-644. doi: 10.1377/hlthaff.2014.0855
Nichols D, Haber S, Romaire M, Wiener J. Evaluation of the Multi-Payer Advanced Primary Care
Practice (MAPCP) Demonstration Second Annual Report. 2016. https://downloads.cms.gov/files/cmmi/mapcp-secondevalrpt.pdf
Rosenthal MB, Alidina S, Friedberg MW, et al. Impact of the Cincinnati aligning forces for quality multi-payer patient centered medical home pilot on health care quality, utilization, and costs. Med. Care Res. Rev. 2016;73(5):532-545. doi: 10.1177/1077558715618566
Rosenthal MB, Alidina S, Friedberg MW, et al. A difference-in-difference analysis of changes in quality, utilization and cost following the Colorado multi-payer patient-centered Medical home pilot. J. Gen. Intern. Med. 2016;31(3):289-296. doi: 10.1007/s11606-015-3521-1
Rosenthal MB, Sinaiko AD, Eastman D, Chapman B, Partridge G. Impact of the Rochester medical home initiative on primary care practices, quality, utilization, and costs. Med. Care Res. Rev. 2015;53(11):967-973. doi: 10.1097/MLR.0000000000000424
Jackson GL, Powers BJ, Chatterjee R, et al. Improving patient care. The patient centered medical home. A Systematic Review. Ann. Intern. Med. 2013;158(3):169-178. doi: 10.7326/0003-4819-158-3-201302050-00579
Peikes D, Zutshi A, Genevro JL, Parchman ML, Meyers DS. Early evaluations of the medical home: Building on a promising start. Am. J. Manag. Care. 2012;18(2):105-116.
Sinaiko AD, Landrum MB, Meyers DJ, et al. Synthesis of research on patient-centered medical homes
brings systematic differences into relief. Health Aff. (Millwood). 2017;36(3):500-508. doi: 10.1377/hlthaff.2016.1235
Shane DM, Nguyen-Hoang P, Bentler SE, Damiano PC, Momany ET. Medicaid health home reducing costs and reliance on emergency department: evidence from Iowa. Med. Care Res. Rev. 2016;54(8):752-757. doi: 10.1097/MLR.0000000000000555
Jackson GL, Powers BJ, Chatterjee R, et al. Improving patient care. The patient centered medical home.
A Systematic Review. Ann. Intern. Med. 2013;158(3):169-178. doi: 10.7326/0003-4819-158-3-201302050-00579
Sinaiko AD, Landrum MB, Meyers DJ, et al. Synthesis of research on patient-centered medical homes
brings systematic differences into relief. Health Aff. (Millwood). 2017;36(3):500-508. doi: 10.1377/hlthaff.2016.1235
Rhodes KV, Basseyn S, Gallop R, Noll E, Rothbard A, Crits-Christoph P. Pennsylvania's medical home initiative: Reductions in healthcare utilization and cost among Medicaid patients with medical and psychiatric comorbidities. J. Gen. Intern. Med. 2016;31(11):1373-1381. doi: 10.1007/s11606-016-3734-y
Dale SB, Ghosh A, Peikes DN, et al. Two-year costs and quality in the comprehensive primary care initiative. N. Engl. J. Med. 2016;374(24):2345-2356. doi: 10.1056/NEJMsa1414953
Kahn KL, Timbie JW, Friedberg MW, Lavelle TA. Evaluation of CMS FQHC APCP Demonstration: Second annual report. 2015; https://innovation.cms.gov/Files/reports/fqhc-scndevalrpt.pdf.
Nichols D, Haber S, Romaire M, Wiener J. Evaluation of the Multi-Payer Advanced Primary Care Practice (MAPCP) Demonstration Second Annual Report. 2016. https://downloads.cms.gov/files/cmmi/mapcp-secondevalrpt.pdf
Dale SB, Ghosh A, Peikes DN, et al. Two-year costs and quality in the comprehensive primary care
initiative. N. Engl. J. Med. 2016;374(24):2345-2356. doi: 10.1056/NEJMsa1414953
Kahn KL, Timbie JW, Friedberg MW, Lavelle TA. Evaluation of CMS FQHC APCP Demonstration:
Second annual report. 2015; https://innovation.cms.gov/Files/reports/fqhc-scndevalrpt.pdf
Nichols D, Haber S, Romaire M, Wiener J. Evaluation of the Multi-Payer Advanced Primary Care Practice (MAPCP) Demonstration Second Annual Report. 2016. https://downloads.cms.gov/files/cmmi/mapcp-secondevalrpt.pdf
Shane DM, Nguyen-Hoang P, Bentler SE, Damiano PC, Momany ET. Medicaid health home reducing
costs and reliance on emergency department: evidence from Iowa. Med. Care Res.
Rev.2016;54(8):752-757. doi: 10.1097/MLR.0000000000000555
Nichols D, Haber S, Romaire M, Wiener J. Evaluation of the Multi-Payer Advanced Primary Care Practice (MAPCP) Demonstration Second Annual Report. 2016. https://downloads.cms.gov/files/cmmi/mapcp-secondevalrpt.pdf
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