Do Community Care of North Carolina-Induced Changes Spill Over to Non-Target Populations? Public Deposited

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  • March 19, 2019
Creator
  • Lichstein, Jesse
    • Affiliation: Gillings School of Global Public Health, Department of Health Policy and Management
Abstract
  • A robust primary care system is necessary for the delivery of high-quality, efficient health care in the United States. Accordingly, there has been a renewed interest in primary care redesign based off the successes of innovative, primary care-based, quality improvement programs. Quality improvement initiatives target either an entire practice or a particular group within a practice. Programs such as Community Care of North Carolina (CCNC) use the latter, targeting Medicaid patients within a practice. An important policy-relevant question is whether intervention-induced changes in how providers care for a patient sub-population affect care for non-target populations within the same practice; this effect is termed spillover. The objective of this dissertation was to examine spillover effects in CCNC, an enhanced primary care case management program for North Carolina's Medicaid population, between 2002 and 2008. It examined the extent to which NC State Employees Health Plan (SHP) diabetes patients in CCNC practices experienced greater improvements in quality of care, utilization, and SHP paid medical expenditures than SHP diabetes patients in non-CCNC practices. The central hypothesis of this study was that improvements in quality, utilization, and costs due to CCNC-induced changes in patient care also accrued among non-Medicaid diabetes patients in CCNC practices. In the main analyses, I found evidence of spillover for only one (receipt of yearly A1c hemoglobin test) of the four quality of care measures, and two (primary care visits and total outpatient visits) of the five utilization measures, though the effects on primary care visits and outpatient visits were not in the hypothesized direction. I found no evidence of spillover for medical expenditures. Overall this study found minimal evidence of spillover in CCNC. The results from this study aid in understanding the full effects of the innovative primary care models that are currently a focus of health policy, and indicate that spillover is not a foregone conclusion. My findings suggest the potential need for all insurers to participate in and coordinate efforts to improve the health and health care of patients.
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  • In Copyright
Advisor
  • Holmes, George M.
  • DeWalt, Darren
  • Weinberger, Morris
  • Silberman, Pam
  • Domino, Marisa
Degree
  • Doctor of Philosophy
Degree granting institution
  • University of North Carolina at Chapel Hill Graduate School
Graduation year
  • 2014
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  • Chapel Hill, NC
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