This study found that, after accounting for differential case mix, the MSHO program resulted in lower prevalence and intensity of inpatient and ED use, and greater outpatient primary care access. Importantly, the study also found no difference in long-term nursing home use between MSHO and MSC+ in spite of the case mix differences. We also found that our findings on the impacts of MSHO are robust to alternative assumptions about the extent of selection bias due to omitted variables, with the potential impacts of MSHO likely even larger if we were able to control for those variables. Thus, if anything, we likely underestimate the impacts of MSHO.
Minnesota staff had previously reported using simple descriptive statistics of MSHO service use measures that did not account for differential case mix and other unobserved factors that MSHO led to lower inpatient setting use, but this study provided an objective, scientifically rigorous assessment of the level of impact. In addition, the MSHO program also resulted in greater access to HCBS, compared to the MSC+ program. These findings suggest that additional initiatives that use fully integrated care models similar to the MSHO program may have merit for other states. CMS and 12 states (including Minnesota) are currently participating in the FAI to improve care for dual eligibles using either managed fee for service or fully capitated models. This study found that one type of capitated model represented by the MSHO program has great potential for improving outcomes for dual eligibles.