The Effects of Case Management in a Medicaid Managed Care Plan

This study will assign participants based on Zip Code to one of two conditions: control and
experimental. In the control group, participants will receive telephonic assessments at
baseline, three months, and six months. These assessments will be conducted by a member of
the Medical Center’s Department of Geriatrics under the supervision of the Principal
Investigator. Participants in the experimental group will receive medical case management
provided by a nurse and social worker in the homecare setting including an in-home
assessment. Assessments will be conducted at baseline, three months, and six months during
routine homecare visits. Dependent variables being measured include: access to primary care
physicians, emergent hospitalizations/admissions, articulation of advance directives, and
quality of life. Data will be collected through the participants’ medical claims and records
to analyze the number of emergent hospitalizations/admissions, documentation of advance
directives, and number of visits to primary care physicians. To measure participants’
quality of life, the Depression Self-Rating Scale and the Clinical Anxiety Scale will be
utilized. Data will be compared between and within the groups via statistical analyses. The
researcher will conduct pre-post comparisons of utilization and other database-derived
outcomes for both groups, comparing the 12 months prior to and up to 20 months following
enrollment.

Inclusion Criteria:

- participation in a Medicaid managed care plan

- resident of identified zip codes in Brooklyn, NY

- frequent hospitalizations and low frequency of primary doctor visits

Exclusion Criteria:

- residents outside the catchment area

- patients not being managed in a Medicaid managed care plan