University of Massachusetts - Amherst
Principal Investigator: Sarah L. Goff, MD, PhD
Funded by the National Heart, Lung, and Blood Institute (NHLBI)
Study Years: 2021-2026
Asthma is the most common chronic disease in childhood and a leading cause of preventable emergency room visits, hospitalizations, school absences, and lost parental workdays. Traditional fee-for-service payment models do not support scaling up multi-level interventions (healthcare, school, and home) that take into account and address the complex, socially determined conditions that exacerbate asthma and drive racial and ethnic disparities in asthma outcomes.
In 2018, Massachusetts launched 17 new Medicaid accountable care organizations (ACOs). Our study takes advantage of this "natural experiment" unfolding in MA by studying the effect of these ACOs on pediatric asthma quality of care and outcomes.
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We are using a mixed methods approach to explore this topic: we measure changes in quality and utilization indicators before and after ACO implementation using the All Payer Claims Data Set, with a focus on how the ACOs have influenced health outcomes for Medicaid-insured children. We will also develop a taxonomy of ACO organizational structures using surveys and qualitative interviews and focus groups with patients, frontline providers, and ACO leaders.
Investigators
Principal Investigator, University of Massachusetts-Amherst
Co-Investigator, UMass Chan Medical School - Baystate
Co-Investigator, University of Massachusetts Medical School
Co-Investigator, University of Illinois
Co-Investigator, UMass Chan Medical School - Baystate
Advisory Board
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Stacey Chacker, Health Resources in Action
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Sarita Hudson, Public Health Institute of Western Massachusetts
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Bridgette Jones, University of Missouri-Kansas City School of Medicine
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Aneida Molina Flores, Revitalize CDC
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Matthew Sadof, University of Massachusetts Chan Medical School - Baystate
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Michelle Warner, Department of Public Health
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Chrystal Wittcopp, Health New England and BeHealthy Partnership
Related Publications
Medicaid Accountable Care Organizations and Disparities in Pediatric Asthma Care
Kimberley H. Geissler, Meng-Shiou Shieh, Arlene S. Ash, Peter K. Lindenauer, Jerry A. Krishan, Sarah L. Goff
JAMA Pediatrics, September 2024
​This difference-in-differences cross-sectional study found no change in routine asthma visits, an increase in appropriate asthma medication ratios, and an increase in emergency department or hospital use for Medicaid-insured vs privately insured child-years following Medicaid ACO implementation. During the first 3 years of Massachusetts’ Medicaid ACO program, there was no clear evidence of success at reducing disparities in asthma care and outcomes for children insured by Medicaid compared to children with private insurance.
Kimberley H. Geissler, PhD; Meng-Shiou Shieh, PhD; Jerry A. Krishnan, MD, PhD; Peter K. Lindenauer, MD, MSc; Arlene S. Ash, PhD; Sarah L. Goff, MD, PhD​
JAMA Network Open, June 2024
In this cross-sectional study, children with asthma who had Medicaid were less likely to receive outpatient specialty care than those with private insurance; the gap was even greater among children with persistent asthma, for whom specialty care may be particularly important. These findings suggest that less specialist care among children with public vs private insurance may contribute to disparities in asthma outcomes.
Differences in Health Care Utilization for Asthma by Children with Medicaid versus Private Insurance
Sarah L. Goff, PhD; Meng-Shiou Shieh, PhD; Peter K. Lindenauer, MD, MSc; Arlene S. Ash, PhD; Jerry A. Krishnan, MD, PhD; and Kimberley H. Geissler, PhD​
Population Health Management, April 2024
Asthma is the most common chronic disease in children, disproportionately affects families with lower incomes, and is a leading reason for acute care visits and hospitalizations. This retrospective cohort study used the Massachusetts All Payer Claims Database (2014–2018) to examine differences in acute care utilization and quality of care for asthma between Medicaid- and privately insured children in Massachusetts.
Kimberley H Geissler, Meng-Shiou Shieh, Valerie Evans, Peter K Lindenauer, Arlene S Ash, Jerry A Krishnan, Sarah L Goff​​
Academic Pediatrics, March 2023
Annual influenza vaccination rates for children remain well below the Healthy People 2030 target of 70%. We aimed to compare influenza vaccination rates for children with asthma by insurance type and to identify associated factors. Despite clear recommendations for annual influenza vaccinations for children with asthma, low rates persist, particularly for children with Medicaid. Offering vaccines in non-office settings such as retail pharmacies may reduce barriers, but we did not observe increased vaccination rates in the first years after this policy change.