Cross-Continuum Tool Is Associated with Reduced Utilization and Cost for Frequent High-Need Users

Area of Science:

• Health Services Research
• Quality Improvement
• Healthcare Management

Background:

• High-need, high-cost (HNHC) patients often overuse acute care services, driving up U.S. healthcare costs and leading to poor outcomes.
• Fragmentation in healthcare systems contributes to inefficient care delivery for HNHC populations.
• Optimizing care systems is crucial for reducing healthcare expenditures and improving patient health.

Purpose of the Study:

• To evaluate the impact of an interdisciplinary intervention, the Complex Care Map (CCM)©, on healthcare utilization and costs.
• To determine if CCMs© can reduce fragmentation and improve care coordination for HNHC patients.
• To assess the effect of CCMs© on healthcare costs and patient outcomes.

Main Methods:

• A pre-/post-test design quality improvement project was conducted at a Midwestern urban hospital.
• 339 HNHC patients with ≥3 hospital visits in 12 months prior were included; individualized CCMs© were created and integrated into the EMR.
• Healthcare utilization, costs, and social/access variables were compared for 12 months pre- and post-CCM© implementation.

Main Results:

• Significant reductions observed in emergency department (ED) visits (-43%), inpatient admissions (-44%), and outpatient visits (-17%).
• Substantial decreases in computed tomography (CT) scans (-62%) and observation/inpatient (OBS/IP) length of stay (-41%).
• Gross charges decreased by 45%, direct expenses by 47%, with notable improvements in contribution margin (+11%) and operating margin (+73%).
• Improvements in patient social determinants: housing (+14%), primary care access (+15%), and insurance coverage (+16%).

Conclusions:

• Individualized Complex Care Maps (CCMs)© are effective in reducing healthcare system overutilization among HNHC patients.
• The CCM intervention is associated with significant cost savings for the healthcare system.
• CCMs© positively impact patient access to essential services like primary care and insurance.