Left behind again: Rural home health services in a Medicaid pediatric accountable care organization

• Published in: The Journal of rural health Vol. 38; no. 2; pp. 420 - 426
• Main Authors: Hardy, Rose Y., Liu, Gilbert C., Conkol, Kimberly J., Gleeson, Sean P., Kelleher, Kelly J.
• Format: Journal Article
• Language: English
• Published: England Wiley Subscription Services, Inc 01-03-2022; John Wiley and Sons Inc
• Subjects: Access; access to care; Accountable Care Organizations; Child; Children; Children & youth; Children with disabilities; Disabilities; Educational attainment; Emergency medical care; Emergency medical services; Emergency Service, Hospital; Emergency services; Financing; Government programs; Health care; Health care delivery; Health services; home care services; Home health care; home health services; Humans; Inpatient care; Medicaid; Original; Pediatrics; Preventive medicine; Return on investment; Rural areas; Rural communities; Rural Health Services; rural pediatric care; Rural Population; Rural urban differences; Statistics; United States; Urban areas; Urban Population; Urban populations; utilization of health services; Visits; Workforce; United States; home health services; utilization of health services; rural pediatric care; access to care; Medicaid; home care services
• ISSN: 0890-765X; 1748-0361
• DOI: 10.1111/jrh.12587

Purpose
To contrast trends in rural and urban pediatric home health care use among Medicaid enrollees.
Methods
Medicaid administrative claims data were used to assess differences in home health care use for child members in a large pediatric accountable care organization (ACO) in Ohio. Descriptive statistics assessed rural and urban differences in health care use over a 10‐year period between 2010 and 2019.
Findings
Pediatric home health care use increased markedly in the low‐income (CFC) and disabled (ABD) Medicaid categories. Over the past 10 years, CFC‐enrolled children from urban communities have seen more home health visits, fewer emergency department (ED) visits, and more well child visits compared to rural CFC‐enrolled children. Children enrolled due to disabilities in urban communities have also seen more home health visit use but fewer preventive care visits than their rural counterparts.
Conclusions
Within a pediatric ACO, rural home health care use has remained relatively stagnant over a 10‐year period, a stark contrast to increases in home health care use among comparable urban populations. There are likely multiple explanations for these differences, including overuse in urban communities, lack of access in rural communities, and changes to home health reimbursement. More can be done to improve rural home health access. Such improvement will likely necessitate large‐scale changes to home health care delivery, workforce, and financing. Improvements should be evaluated for return‐on‐investment not only in terms of direct costs, that is, reduced inpatient or ED costs, but also in terms of patient and family quality‐of‐life or key indicators of child well‐being such as educational attainment.