Impact of a geriatric case management program on health plan costs

We evaluated the impact of HIP, Health Plan of New York's geriatric case management (GCM) program, which is offered to Medicare Advantage members at high risk for high health care costs and utilization. The study design was a comparison of health plan costs for program participants and nonparticipants eligible for the program, controlling for variables predictive of high health care costs measured prior to program enrollment. The GCM program's impact on health care cost was derived from regression models comparing the costs of 101 program participants without exposure to other disease management programs to 1585 eligible nonparticipants, controlling for age, sex, and health care costs in the pre-program period. Net costs or savings from the program were computed as the sum program operation costs and the estimated change in health care costs associated with program participation. Mean annual health care costs for each program participant were $7720 lower than for eligible nonparticipants (P = .0090). The lower health care costs were attributable to the lower costs for inpatient and outpatient hospital and skilled nursing facility settings, exceeding the higher costs for physician office visits and prescription drugs. Estimated program costs were $2755 per member managed by the program, yielding a net savings of $4965 per member enrolled. A GCM program was successfully implemented in a large Medicare Advantage program. The reductions in health care costs achieved through GCM exceeded program costs resulted in meaningful savings for the health plan.