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. 2022 Mar;38(2):420-426.
doi: 10.1111/jrh.12587. Epub 2021 May 12.

Left behind again: Rural home health services in a Medicaid pediatric accountable care organization

Rose Y Hardy  1 , Gilbert C Liu  2   3 , Kimberly J Conkol  2 , Sean P Gleeson  2   3 , Kelly J Kelleher  1   3
Affiliations

Left behind again: Rural home health services in a Medicaid pediatric accountable care organization

Rose Y Hardy et al. J Rural Health. 2022 Mar.

Abstract

Purpose: To contrast trends in rural and urban pediatric home health care use among Medicaid enrollees.

Methods: Medicaid administrative claims data were used to assess differences in home health care use for child members in a large pediatric accountable care organization (ACO) in Ohio. Descriptive statistics assessed rural and urban differences in health care use over a 10-year period between 2010 and 2019.

Findings: Pediatric home health care use increased markedly in the low-income (CFC) and disabled (ABD) Medicaid categories. Over the past 10 years, CFC-enrolled children from urban communities have seen more home health visits, fewer emergency department (ED) visits, and more well child visits compared to rural CFC-enrolled children. Children enrolled due to disabilities in urban communities have also seen more home health visit use but fewer preventive care visits than their rural counterparts.

Conclusions: Within a pediatric ACO, rural home health care use has remained relatively stagnant over a 10-year period, a stark contrast to increases in home health care use among comparable urban populations. There are likely multiple explanations for these differences, including overuse in urban communities, lack of access in rural communities, and changes to home health reimbursement. More can be done to improve rural home health access. Such improvement will likely necessitate large-scale changes to home health care delivery, workforce, and financing. Improvements should be evaluated for return-on-investment not only in terms of direct costs, that is, reduced inpatient or ED costs, but also in terms of patient and family quality-of-life or key indicators of child well-being such as educational attainment.

Keywords: Medicaid; access to care; home care services; home health services; rural pediatric care; utilization of health services.

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Conflict of interest statement

Dr. Gleeson is the President of Partners for Kids. Dr. Liu is the Medical Director for Partners for Kids. Ms. Conkol is the Vice President of Care Coordination. Dr. Hardy's post‐doctoral scientist position is partially funded by Partners for Kids.

Figures

FIGURE 1
FIGURE 1
Total home health visit use by Medicaid program and rurality, 2010‐2019 Abbreviations: ABD, aged, blind, and disabled; AFK, adoptive, foster, and kinship care; CFC, covered families and children. Scales differ by Medicaid program
See this image and copyright information in PMC

References

    1. Boss RD, Raisanen JC, Detwiler K, et al. Lived experience of pediatric home health care among families of children with medical complexity. Clin Pediatr (Phila). 2020;59(2):178‐187. - PubMed
    1. Maynard R, Christensen E, Cady R, et al. Home health care availability and discharge delays in children with medical complexity. Pediatrics. 2019;143(1):e20181951. - PubMed
    1. Berry JG, Hall M, Dumas H, et al. Pediatric hospital discharges to home health and postacute facility care: a national study. JAMA Pediatr. 2016;170(4):326‐333. - PubMed
    1. Clemens CJ, Davis RL, Novack AH, Connell FA. Pediatric home health care in King County, Washington. Pediatrics. 1997;99(4):581‐584. - PubMed
    1. Rural Home Health Services . https://www.ruralhealthinfo.org/topics/home‐health#rural‐availability. Published 2020. Accessed June 23, 2020.