Quality of care and use of the medical home in a state-funded capitated primary care plan for low-income children

Objective. To evaluate the quality of care and use of the medical home in a state-funded capitated insurance plan for low-income children-the Colorado Child Health Plan (CCHP). Design. A retrospective cohort study using medical record review at pediatr ic and family practice offices in 4 geographic areas of Colorado. At each p ractice, CCHP-enrolled children (6 months to 6.5 years) and 2 controls were selected, 1 with Medicaid (MK) and 1 with private insurance (PI), matched by date of birth to the CCHP-enrolled child (N = 596). CCHP-enrolled childr en with a diagnosis of asthma, aged 3 to 18 years, and asthmatic children w ith MK and PI, matched by age, were also selected from each practice (N = 1 39). Results. Quality of preventive services were comparable in the 3 groups. CC HP-enrolled children made more health maintenance visits than MK-enrolled c hildren (1.3 CCHP vs .9 MK vs 1.1 PI) and were more frequently screened for lead (8.1% CCHP vs 3.4% MK vs 1.2% PI) and anemia (5.0% CCHP vs 4.4% MK vs 2.4% PI) than children in either control group. Documented immunization ra tes were similar in the 3 groups, but a shift in location of immunization f rom public health clinics to the primary care site was seen in the CCHP gro up. CCHP-enrolled children made more office visits for acute care than did MK-enrolled children (4.1 CCHP vs 3.1 MK vs 3.4 PI), but a higher proportio n of these visits took place at the medical home rather than the emergency department for the CCHP group (.04) as compared with the MK (.07) or PI (.0 6) groups. Asthmatic children in the CCHP group made more preventive office visits for maintenance therapy and more frequently used the primary care s ite rather than the emergency department for acute exacerbations than did c hildren with PI (mean ratio of emergency department visits to total acute v isits .04 CCHP vs .06 MK vs .19 PI). Conclusions. Despite capitated reimbursement for primary care services, CCH P provided children from low-income families with preventive, acute, and ch ronic care services of comparable quantity and quality to those received by children with MK or PI. The program was associated with a shift of immuniz ation location to the primary care site and increased health maintenance ca re for new enrollees. CCHP-enrolled children used their medical home for th e majority of acute health needs and were not high utilizers of emergency d epartment or hospital services.