Continuous Coverage – Critical for Chronic Conditions

By Tara Mancini

Our Say Ahhh! audience is certainly aware of the benefits of implementing continuous coverage, namely, how it can improve health outcomes for beneficiaries while also decreasing administrative and utilization costs.  As of January 1, 2012, 28 states offer 12-month continuous eligibility in their CHIP programs (23 in Medicaid).  Alabama is one of those states, and is the subject of a study that recently appeared in “Clinical Pediatricians”.  This study focuses on children with chronic asthma in Alabama’s CHIP program, “ALL Kids,” and furthers the case for the states that haven’t yet chosen to take up the continuous coverage option.

      In order to examine the utilization of asthma-related care and its associated costs, the researchers identified CHIP enrollees with persistent asthma who were continuously enrolled in ALL Kids for at least three years between 1998 and 2009.  Matching billing codes for treatment or prescriptions that met the definition of asthma used by the Healthcare Effectiveness Data and Information Set (HEDIS), 1,954 children with persistent asthma were identified for the study.

      Controlling for age, gender and calendar year of enrollment, the findings show an overall decline in utilization of asthma related care in subsequent years of enrollment, when compared to the first year of enrollment. In addition, costs – which were adjusted for inflation and included any required CHIP payments – also decreased when compared between the first and subsequent years.

      The particular areas where utilization of services and medication subsided were hospitalizations, emergency visits, outpatient visits, and both quick relief and long-term control prescriptions. The decline in asthma related emergency visits experienced the most marked improvement, declining seven percentage points between the first (10%) and second year (3%) and continued to decline to 2% in the third year. Asthma related hospitalizations also decreased from 6% in the first year to 2% in the second year, where they remained constant in the third year.Outpatient visits also diminished from an average of 1.46 visits a year, to 1.12 in the second year and less than one in the third (0.94). In terms of medication, those prescribed for long-term control dwindled from an average of 5.8 in the first year to 4.4 in the third year.  Quick relief prescriptions experienced a smaller decline in utilization from an average of 2.6 prescriptions in the first year to 2.1 in the third year. 

      So what kind of savings do these decreases in care utilization amount to?  Total costs for all asthma related care dropped from an average of $1,395 in the first year, to $1,281 in the second year, and $1,134 in the third year, an average savings of $261 dollars. Inpatient services experienced the biggest dollar decline in services, saving $207 over three years. In regard to medications, average costs for long-term control prescriptions had bigger savings than average costs for quick-relief medications, $115 vs. $14.

      Researchers suggest that the decrease in care utilization, and consequently costs, may be due to families having regular access to outpatient services which allow them to be better educated about their asthma, and allow for better self-management of the disease.

      This study illustrates the impact that having access to a usual source of care can have on treating chronic asthma, which according to the study is one of the most prevalent chronic diseases experienced by children in the U.S. In addition, it has implications for how children with other chronic health conditions stand to benefit from access to continuous care.