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Tacking upwind: reducing spending among high-risk commercially insured patients.

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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.

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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.