Related Experiment Video
Updated: Jul 29, 2025
Inverse Probability of Treatment Weighting Propensity Score using the Military Health System Data Repository and National Death Index
Published on: January 8, 2020
Tacking upwind: reducing spending among high-risk commercially insured patients
Nicole M Benson1, Mary Price, Max Weiss
1McLean Hospital, Harvard Medical School, 115 Mill St, Belmont, MA 02478.
Insights
An integrated care management program significantly reduced medical spending and hospitalizations for high-risk patients within a commercial accountable care organization (ACO). Identifying these patients is key for cost savings.
Area of Science:
- Health Services Research
- Healthcare Management
- Population Health Management
Background:
- Commercial accountable care organization (ACO) populations are typically healthy but can include high-risk individuals.
- Effective care management programs are crucial for optimizing outcomes and controlling costs in ACOs.
Purpose of the Study:
- To assess the impact of an integrated care management program on medical spending and clinical event rates within a commercial ACO.
- To identify high-risk patients who may benefit from intensive care management.
Main Methods:
- Retrospective cohort study of 365,413 individuals (aged 18-64) within the Mass General Brigham health system (2015-2019).
- Analysis of medical spending claims and enrollment data for patients in a commercial ACO, focusing on 487 high-risk individuals.
- Utilized a staggered difference-in-difference design with individual-level fixed effects to compare program participants with similar non-participants.
Main Results:
- Patients in the integrated care management program experienced a $1361 reduction in monthly medical spending per person.
- The program was associated with lower rates of emergency department visits and hospitalizations compared to a control group.
- Adjustments for early ACO departure indicated expected reductions in program effect magnitude.
Conclusions:
- Commercial ACOs, despite average health, contain high-risk patient subgroups requiring targeted interventions.
- Identifying patients who can benefit from intensive care management is critical for realizing potential cost savings in ACO models.
Objectives:
The study examined a commercial accountable care organization (ACO) population and then assessed the impact of an integrated care management program on medical spending and clinical event rates.
Study Design:
Retrospective cohort study of high-risk individuals (n = 487) in a population of 365,413 individuals aged 18 to 64 years within the Mass General Brigham health system who were part of commercial ACO contracts with 3 large insurers between 2015 and 2019.
Methods:
Using medical spending claims and other enrollment data, the study assessed the demographic and clinical characteristics, medical spending, and clinical event rates of patients in the ACO and its high-risk care management program. The study then examined the impact of the program using a staggered difference-in-difference design with individual-level fixed effects and compared outcomes of those who had entered the program with those of similar patients who had not entered.
Results:
The commercially insured ACO population was healthy on average but included several hundred high-risk patients (n = 487). After adjustment, patients within the ACO's integrated care management program for high-risk patients had lower monthly medical spending (by $1361 per person per month) as well as lower emergency department visit and hospitalization rates compared with similar patients who had yet to start the program. Accounting for early ACO departure decreased the magnitude of the program effects as expected.
Conclusions:
Commercial ACO populations may be healthy on average but still include some high-risk patients. Identifying which patients might benefit from more intensive care management could be critical for reaping the potential savings.
Related Concept Videos
01:30Preventive Healthcare Services
01:18Introduction To Health Care Delivery System
The Institute of Medicine (IOM) advocates for a patient-centered, effective, safe, timely, equitable, and effective healthcare system. The National Priorities...
01:30Health Information Technology and Healthcare Information System
Health Information Technology, commonly called HIT, integrates advanced information systems and technology in healthcare settings. Its primary functions include:
01:26Methods Of Healthcare Delivery System
Managed Care System:
The managed care system is designed to control the cost while maintaining the quality of care. The patient's care from admission to discharge is planned by the primary care provider or the case manager, also known as the gatekeeper. In a managed care system, the number of care providers is...
01:22Healthcare Associated Infections II: Preventive Measures
The best practices for preventing healthcare-associated infections include hand hygiene, patient risk...
01:29Issues And Trends In Healthcare Delivery System
Cost Containment
Payment for healthcare services has historically promoted adoption of costly and often unnecessary or inefficient...