MSHO HMOs may put marketing materials, audited and approved by the State and the Centers for Medicare and Medicaid Services (CMS), in NHs, hospitals, and clinics, but they are not permitted to send salespersons there.
A prior evaluation found that MSHO reduced inpatient hospital utilization, emergency room (ER) and physician visits for NH residents, and physician visits for community residents compared with controls during its first 3 years of operation (Kane, Homyak, Bershadsky et al.
This study examined the existence and degree of selection bias from unobserved variables and the MSHO effects on utilization after adjusting for selection bias.
Monthly eligibility data for all dual eligibles in the Twin Cities' metropolitan area and Medicare and Medicaid encounter data for all MSHO enrollees came from the Minnesota Department of Human Services (MDHS).
Dual eligibles from Washington and Scott counties were excluded because of very late MSHO program enrollment.
Health care utilization is conceptualized as a function of the dual eligibles' demographics, health and frailty status, MSHO program choice or exposure time, county characteristics, and unobserved relevant variables.
MSHO is a voluntary demonstration program that integrates acute care and LTC for dually eligible elderly people.
The eligible populations in Texas STAR+PLUS, MSHO, and CCN are not limited to those who are NHC.
In MSHO, the rate structure differentiates between an institutional and non-institutional rate for Medicaid acute and ancillary services.
Room and board are included in the capitation for all of the programs except for MSHO. Nursing facility per diems are paid directly by the State for those who enroll in MSHO while in a nursing facility or after 180 days if a community-dwelling enrollee enters a nursing facility.
In MSHO, plans are at risk for the first 180 days of nursing home care for enrollees living in the community and thereafter are reimbursed at the FFS cost.
This differs from MSHO, Texas STAR+PLUS, and CCN, which place plans at risk on an individual-enrollee level, limiting plan liability to a certain number of days.