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Identifying catastrophic psychiatric cases. Targeting managed-care strategies
J M Goldstein1, E L Bassuk, S K Holland
1Bigel Institute for Health Policy, Heller Graduate School, Brandeis University, Waltham, MA 02254.
Medical Care
|August 1, 1988
Summary
Case management programs should use more than diagnosis to identify high-cost patients. Including factors like age and treatment setting improves targeting for better cost and quality outcomes.
Area of Science:
- Healthcare Management
- Health Services Research
- Medical Economics
Background:
- Case management programs, a form of utilization review (UR), target high-cost catastrophic cases.
- Current identification methods often rely solely on diagnosis, which is a poor predictor of healthcare costs and length of stay.
Purpose of the Study:
- To develop an empirical approach for identifying potentially catastrophic cases more effectively.
- To improve the targeting of case management interventions for better cost-efficiency and patient care.
Main Methods:
- Utilized claims data from a large nationwide insurer.
- Developed and applied an empirical model incorporating multiple factors beyond diagnosis.
Main Results:
- Diagnosis alone is insufficient for identifying patients with long stays and high costs.
- Factors such as patient age and treatment setting significantly contribute to high costs and extended stays.
- An empirical approach incorporating these additional factors enhances case identification for case management.
Conclusions:
- Case management strategies should integrate a broader set of criteria, including age and treatment setting, for optimal patient identification.
- Effective case management requires balancing cost reduction with the maintenance of high-quality patient care.
- Refining case identification methods can lead to more efficient and impactful healthcare resource allocation.