Effects of a community-based care management model for super-utilizers

Area of Science:

• Health Services Research
• Healthcare Management
• Public Health Policy

Background:

• High-cost patients with complex needs challenge Medicare, Medicaid, and commercial insurers.
• Effective interventions are sought to improve outcomes and manage costs for these populations.

Purpose of the Study:

• To evaluate the effectiveness of a high-intensity care management program adapted from the Camden Coalition model.
• To assess the program's impact on utilization and spending for Medicare fee-for-service beneficiaries.

Main Methods:

• A subgroup of Medicare fee-for-service beneficiaries (n=149) enrolled in the program.
• A matched comparison group (n=1130) constructed using propensity score matching.
• Medicare claims data analyzed with regression models over a 12-month period.

Main Results:

• The program demonstrated an aggregate reduction in service use and spending (P = .012).
• Unplanned readmissions decreased by 37% (P = .086) among participants.
• While individual outcome significance varied, confidence intervals suggested potentially large effects.

Conclusions:

• Adaptations of the Camden model show potential for reducing short-term service use and spending.
• The findings suggest promise for managing Medicare super-utilizers through intensive care management.
• Mixed results indicate a need for further research on specific outcome impacts.