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Pediatric Specialty Care Model for Management of Chronic Respiratory Failure: Cost and Savings Implications and
Robert J Graham1,2, Michael L McManus1,2, Angie Mae Rodday3,4
1Division of Critical Care, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA.
Insights
A critical care-based care coordination model for medically complex children with chronic respiratory failure saved $1.2-2 million annually. This program reduced emergency department visits and hospitalizations, demonstrating cost savings for high-risk pediatric patients.
Area of Science:
- Pediatric critical care medicine
- Healthcare management and economics
- Care coordination models
Background:
- Medically complex children with chronic respiratory failure represent a high-cost patient population.
- Existing care models may not adequately address the multifaceted needs of these children, leading to suboptimal outcomes and high resource utilization.
Purpose of the Study:
- To describe the design, costs, and financial implications of a critical care-based care coordination program.
- To evaluate the impact of this model on resource utilization and cost savings for pediatric patients with chronic respiratory failure.
Main Methods:
- A 4-year prospective and retrospective study using an adapted Care Coordination Measurement Tool.
- Data collection included patient characteristics, program activities, and acute care resource utilization, cross-validated with hospital billing data.
- Cost savings were estimated by monetizing averted emergency department visits and hospitalizations.
Main Results:
- The program served 346 patients, involving 11,960 encounters, including home and telemedicine visits.
- Care coordination activities were integrated into 45% of encounters.
- Estimated annual savings ranged from $1.2 to $2 million, equating to $407 per patient per month, by averting 556 ED visits and 107 hospitalizations.
Conclusions:
- Critical care-based care coordination models can generate immediate cost savings for high-risk, high-cost pediatric populations.
- Evaluating the financial impact of comprehensive care models is crucial alongside clinical outcomes.
- Further research is needed to establish financial sustainability, scalability, and equitable access to such programs.
Objective:
To describe program design, costs, and savings implications of a critical care-based care coordination model for medically complex children with chronic respiratory failure.
Design:
All program activities and resultant clinical outcomes were tracked over 4 years using an adapted version of the Care Coordination Measurement Tool. Patient characteristics, program activity, and acute care resource utilization were prospectively documented in the adapted version of the Care Coordination Measurement Tool and retrospectively cross-validated with hospital billing data. Impact on total costs of care was then estimated based on program outcomes and nationally representative administrative data.
Setting:
Tertiary children's hospital.
Subjects:
Critical Care, Anesthesia, Perioperative Extension and Home Ventilation Program enrollees.
Interventions:
None.
Measurements And Main Results:
The program provided care for 346 patients and families over the study period. Median age at enrollment was 6 years with more than half deriving secondary respiratory failure from a primary neuromuscular disease. There were 11,960 encounters over the study period, including 1,202 home visits, 673 clinic visits, and 4,970 telephone or telemedicine encounters. Half (n = 5,853) of all encounters involved a physician and 45% included at least one care coordination activity. Overall, we estimated that program interventions were responsible for averting 556 emergency department visits and 107 hospitalizations. Conservative monetization of these alone accounted for annual savings of $1.2-2 million or $407/pt/mo net of program costs.
Conclusions:
Innovative models, such as extension of critical care services, for high-risk, high-cost patients can result in immediate cost savings. Evaluation of financial implications of comprehensive care for high-risk patients is necessary to complement clinical and patient-centered outcomes for alternative care models. When year-to-year cost variability is high and cost persistence is low, these savings can be estimated from documentation within care coordination management tools. Means of financial sustainability, scalability, and equal access of such care models need to be established.
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