Effect of Medicaid accountable care on preventable emergency department and hospital admissions: rural-urban heterogeneity

Accountable care organizations provide a framework for collaboration among providers and payers to improve patients' health and care experiences while reducing costs. However, there is limited research on the realization of these benefits for low-income individuals across varying degrees of rur...

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Vydané v:Frontiers in health services Ročník 5; s. 1475140
Hlavní autori: Yoon, Jangho, Ghim, Seungbeen, Luck, Jeff
Médium: Journal Article
Jazyk:English
Vydavateľské údaje: Switzerland Frontiers Media S.A 26.06.2025
Predmet:
accountable care
coordinated care organization
Health Services
Medicaid
Oregon
preventable ED admission
preventable hospital admission
Oregon
USA
preventable hospital admission
accountable care
coordinated care organization
Medicaid
preventable ED admission
ISSN:2813-0146, 2813-0146
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Shrnutí:Accountable care organizations provide a framework for collaboration among providers and payers to improve patients' health and care experiences while reducing costs. However, there is limited research on the realization of these benefits for low-income individuals across varying degrees of rurality. This study examined the heterogeneous impact of Coordinated Care Organizations (CCOs), an accountable care model implemented in Oregon Medicaid, on preventable emergency department (ED) and hospital admissions by rurality of residence. Using person-month panel data on 131,246 adults aged 18-64 continuously enrolled in Oregon Medicaid between 2011 and 2015, we employed a doubly-robust difference-in-differences approach to isolate the impacts of the CCO model on the number of ED visits and the probability of hospital admissions, separately for all-cause and preventable admissions. The CCO model was associated with reductions of 25 all-cause ED visits and 22 preventable ED visits per 1,000 persons per month during the first three years. Significant decreases in all-cause and preventable ED visits were observed across different levels of rurality. However, the magnitude of these reductions decreased almost monotonically as rurality increased from urban to small/isolated rural areas. On average, the CCO model was associated with significant declines in preventable ED visits by 18, 9, and 5 visits per 1,000 persons per month among urban, large rural, and small/isolated rural residents, respectively. No statistically discernable relationship was found for hospital admissions. The CCO model led to significant overall reductions in preventable ED visits. However, this beneficial effect may diminish with increased rurality.
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Edited by: Steven W. Howard, University of Alabama at Birmingham, United States
Songyuan Deng, University of South Carolina, United States
Reviewed by: Zidong Zhang, Saint Louis University, United States
ISSN:2813-0146
2813-0146
DOI:10.3389/frhs.2025.1475140