Implications for cost and access of site-of-service referrals for ancillary medical services in a US Medicaid population: analysis of claims data from Maryland, USA
Objectives Through analysis of claims and payment data, we quantified several implications of shifting ancillary healthcare services from regulated, more expensive to unregulated, less expensive sites. We also quantified the implications of this shift on access to services, with a focus on differenc...
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BMJ Publishing Group
2022-06-01
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| Series: | BMJ Open |
| Online Access: | https://bmjopen.bmj.com/content/12/6/e058104.full |
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| author | Maqbool Dada Simrita Singh Kelsey J Rydland Chester Chambers Vishal Mundlye Edward Kumian Kayode Ayodele Williams |
| author_facet | Maqbool Dada Simrita Singh Kelsey J Rydland Chester Chambers Vishal Mundlye Edward Kumian Kayode Ayodele Williams |
| author_sort | Maqbool Dada |
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| description | Objectives Through analysis of claims and payment data, we quantified several implications of shifting ancillary healthcare services from regulated, more expensive to unregulated, less expensive sites. We also quantified the implications of this shift on access to services, with a focus on differences in access between rural and urban patients for a Medicaid (disadvantaged) population in Maryland, USA.Design Using a dataset of all Medicaid claims records for 1 year, we identified and extracted all bundles of regulated and unregulated ancillary services. Geospatial computing was used to approximate transportation costs required to access services. Including transportation enabled us to estimate net savings of any added transportation costs. We used location-allocation optimisation models to find the optimal sites to minimise net costs.Setting Coverage area included Medicaid patients throughout the state of Maryland.Participants All rural and urban members of this Medicaid cohort.Primary and secondary outcome measures Change in payer costs and member travel times on shifting ancillary bundles from regulated to unregulated sites.Results Procedure cost and travel time differentials between regulated and unregulated sites strongly correlated with the percentage of procedures referred to regulated sites. Shifting regulated bundles to unregulated sites, while imposing the constraint of no increase in travel time, reduced expenditures by 15.9%. This figure exceeded 30% if no limit was placed on travel-time increases.Conclusion With reasonable constraints on allowable travel time increases, shifting ancillary service bundles from regulated to unregulated sites can benefit both patients and payers in terms of cost and access. |
| format | Article |
| id | doaj-art-8152c15019534f7b89534f1402a86cf3 |
| institution | Kabale University |
| issn | 2044-6055 |
| language | English |
| publishDate | 2022-06-01 |
| publisher | BMJ Publishing Group |
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| series | BMJ Open |
| spelling | doaj-art-8152c15019534f7b89534f1402a86cf32025-01-27T13:10:10ZengBMJ Publishing GroupBMJ Open2044-60552022-06-0112610.1136/bmjopen-2021-058104Implications for cost and access of site-of-service referrals for ancillary medical services in a US Medicaid population: analysis of claims data from Maryland, USAMaqbool Dada0Simrita Singh1Kelsey J Rydland2Chester Chambers3Vishal Mundlye4Edward Kumian5Kayode Ayodele Williams63 Carey Business School, Johns Hopkins University, Baltimore, Maryland, USA1 Leavey School of Business, Santa Clara University, Santa Clara, California, USA2 Geospatial and Data Services, Northwestern University, Evanston, Illinois, USA3 Carey Business School, Johns Hopkins University, Baltimore, Maryland, USA4 Johns Hopkins HealthCare LLC, Baltimore, Maryland, USA4 Johns Hopkins HealthCare LLC, Baltimore, Maryland, USA5 Anesthesiology and Critical Care Medicine, Division of Pain Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, USAObjectives Through analysis of claims and payment data, we quantified several implications of shifting ancillary healthcare services from regulated, more expensive to unregulated, less expensive sites. We also quantified the implications of this shift on access to services, with a focus on differences in access between rural and urban patients for a Medicaid (disadvantaged) population in Maryland, USA.Design Using a dataset of all Medicaid claims records for 1 year, we identified and extracted all bundles of regulated and unregulated ancillary services. Geospatial computing was used to approximate transportation costs required to access services. Including transportation enabled us to estimate net savings of any added transportation costs. We used location-allocation optimisation models to find the optimal sites to minimise net costs.Setting Coverage area included Medicaid patients throughout the state of Maryland.Participants All rural and urban members of this Medicaid cohort.Primary and secondary outcome measures Change in payer costs and member travel times on shifting ancillary bundles from regulated to unregulated sites.Results Procedure cost and travel time differentials between regulated and unregulated sites strongly correlated with the percentage of procedures referred to regulated sites. Shifting regulated bundles to unregulated sites, while imposing the constraint of no increase in travel time, reduced expenditures by 15.9%. This figure exceeded 30% if no limit was placed on travel-time increases.Conclusion With reasonable constraints on allowable travel time increases, shifting ancillary service bundles from regulated to unregulated sites can benefit both patients and payers in terms of cost and access.https://bmjopen.bmj.com/content/12/6/e058104.full |
| spellingShingle | Maqbool Dada Simrita Singh Kelsey J Rydland Chester Chambers Vishal Mundlye Edward Kumian Kayode Ayodele Williams Implications for cost and access of site-of-service referrals for ancillary medical services in a US Medicaid population: analysis of claims data from Maryland, USA BMJ Open |
| title | Implications for cost and access of site-of-service referrals for ancillary medical services in a US Medicaid population: analysis of claims data from Maryland, USA |
| title_full | Implications for cost and access of site-of-service referrals for ancillary medical services in a US Medicaid population: analysis of claims data from Maryland, USA |
| title_fullStr | Implications for cost and access of site-of-service referrals for ancillary medical services in a US Medicaid population: analysis of claims data from Maryland, USA |
| title_full_unstemmed | Implications for cost and access of site-of-service referrals for ancillary medical services in a US Medicaid population: analysis of claims data from Maryland, USA |
| title_short | Implications for cost and access of site-of-service referrals for ancillary medical services in a US Medicaid population: analysis of claims data from Maryland, USA |
| title_sort | implications for cost and access of site of service referrals for ancillary medical services in a us medicaid population analysis of claims data from maryland usa |
| url | https://bmjopen.bmj.com/content/12/6/e058104.full |
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