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An assessment of Maryland Medicaid's Rare and Expensive Case Management Program
S K Pandey1, M G Mussman, H W Moore
1Rutgers University, Camden, USA.
Insights
The Rare and Expensive Case Management Program shifted costs from acute to non-acute care for pediatric beneficiaries. This intensive case management improved service delivery and expenditure patterns.
Area of Science:
- Health Services Research
- Pediatric Healthcare Management
- Healthcare Economics
Background:
- The Rare and Expensive Case Management Program offers intensive support to vulnerable pediatric patients.
- Evaluating the program's impact on healthcare costs presented challenges due to low patient prevalence.
Purpose of the Study:
- To examine how the case management program affects healthcare expenditure patterns.
- To assess the shift in costs from acute to non-acute services.
Main Methods:
- A retrospective study compared Medicaid beneficiaries in the program with a historical control group.
- Statewide Medical Assistance claims data were used to model a historical comparison group.
- The study analyzed cost patterns before and after program implementation.
Main Results:
- The case management program successfully shifted healthcare expenditures from acute to non-acute services.
- This shift aligns with the program's goal of providing timely medical and assistive care.
- The innovative methodological approach enabled effective evaluation despite comparison group challenges.
Conclusions:
- Intensive case management can alter healthcare cost structures in pediatric populations.
- The program demonstrates a successful model for managing costs in rare and expensive conditions.
- Timely access to non-acute services is key to optimizing healthcare spending.
Abstract:
The Rare and Expensive Case Management Program provides intensive case management services to an especially vulnerable population comprised of primarily pediatric beneficiaries. This study examines the effect of the case management program on the pattern of costs. With its emphasis on obviating the need for acute care services and providing the necessary medical and assistive services in a timely manner, the case management program is expected to change the pattern of expenditures by category of service. Due to the low prevalence of conditions covered by the program, constituting a comparison group for the evaluation posed a major challenge. Employing an innovative methodological approach, a historical comparison group was modeled using statewide Medical Assistance claims files. The study design included a retrospective comparison of Medicaid beneficiaries enrolled in the program with a similar group before the case management program was implemented. The results bear out the anticipated pattern of shifts in cost of care from acute care to nonacute care services.