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Administration/Practice Management, Advocacy, Child Health Financing, Emergency Medicine, Pharmacology, System-Based Practice, Therapeutics Three New Medicaid Expenditure Studies Warrant Your Attention and Potential Intervention by Dr Lewis First MD, MA, Editor in Chief, Pediatrics Health insurance reform is an important part of the national dialog. Concerns are raised constantly about limiting Medicaid expenditures. Yet in doing so, what would that mean for children enrolled in Medicaid? Perhaps there are focused strategies we can use to improve the quality and cost-effectiveness of the care Medicaid provides rather than simply pass reform that globally cuts Medicaid spending without focus on who really needs it the most (and children are certainly at the top of that list). This week we release three studies focused on Medicaid spending to better characterize how dollars for Medicaid are being used for children. The first of these, a cross-sectional retrospective study by Hoefgen et al (10.1542/peds.2017-0492) looks at Medicaid expenditures and utilization by level of complexity and chronic illness-in particular how much is spent for children with non-complex chronic disease. The results of this study indicate that about a third of Medicaid expenditures (34.9 billion annually) are for children with non-complex chronic disease who benefit greatly from being in this program. The discussion of these results suggests we can do more to reduce costs while maintaining quality of care delivery to this group of pediatric patients. The second Medicaid study by Peltz et al. (10.1542/peds.2017-0962) represented a longitudinal cohort study of children who repeatedly use the emergency department at high levels in one year who were followed for the next two years to determine if their high ED use continued. The authors demonstrate that one in six children or teens remain high users. Future strategies could targeting these children to improve care and decrease costs. The third study looks at high pharmaceutical use in Medicaid-enrolled children. Cohen et al. (10.1542/peds.2017-1095) share the results of their retrospective cross-sectional study characterizing what were the top 10 of 261 different medication classes associated with highest Medicaid expenditures in children and in turn what are the attributes of these children that will allow us to better identify the medication high-users so as to also implement interventions that can lower Medicaid costs. The authors noted that the top 10 medication classes account for almost two-thirds of all Medicaid medication expenditures with stimulants leading the list. As to who uses the top ten classes, the study notes that children with a complex chronic or mental health condition are most likely to be in this high-user category and demonstrate polypharmacy use in these categories more than children who utilize drugs outside of the top categories. The authors of all three of these studies suggest opportunities for improvement care and reducing costs within Medicaid. This targeted approach is better than simply decreasing Medicaid funding and thus depriving children of this important program. Congress should protect the health of children by assuring access to care. However, we need to remember that our role as child health professionals is to be good stewards of Mediacaid resources. These three studies provide us with identification of focused areas of intervention that may enable our Copyright © 2017 American Academy of Pediatrics
