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How does being part of a pediatric accountable care organization impact health service use for children with disabilities?

Objective: To examine the impact of a Medicaidserving pediatric accountable care organization (ACO) on health service use by children who qualify for Medicaid by virtue of a disability under the “aged, blind, and disabled” (ABD) eligibility criteria.

Data Sources/Study Setting: We evaluated a 2013 Ohio policy change that effectively moved ABD Medicaid children into an ACO model of care using Ohio Medicaid administrative claims data for years 20112016.

Study Design: We used a differenceindifference design to examine changes in patterns of health care service use by ABDenrolled children before and after enrolling in an ACO compared with ABDenrolled children enrolled in nonACO managed care plans.

Data Collection/Extraction Methods: We identified 17 356 children who resided in 34 of 88 counties as the ACO “intervention” group and 47 026 ABDenrolled children who resided outside of the ACO region as nonACO controls.

Principal Findings: Being part of the ACO increased adolescent preventative service and decreased use of ADHD medications as compared to similar children in nonACO capitated managed care plans. Relative home health service use decreased for children in the ACO.

Conclusions: Our overall results indicate that being part of an ACO may improve quality in certain areas, such as adolescent wellchild visits, though there may be room for improvement in other areas considered important by patients and their families such as home health service.

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