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

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.