Does Interdisciplinary Care Team Care Management Improve Health Quality and Demonstrate Cost-Effectiveness?

Area of Science:

• Healthcare Management
• Health Economics
• Population Health

Background:

• Identifying and managing high-risk patients is crucial for controlling healthcare costs.
• Medicare Advantage (MA) beneficiaries represent a significant population with complex health needs.
• Traditional care management programs may not optimally identify or engage all high-risk individuals.

Purpose of the Study:

• To evaluate the impact of an interdisciplinary care teams (IDCT) program on cost and quality outcomes.
• To assess the effectiveness of a novel algorithm in identifying high-risk MA beneficiaries for care management.
• To determine the return on investment for an IDCT care management program.

Main Methods:

• A novel algorithm identified 400 high-risk MA beneficiaries from a pool of 48,235.
• 252 patients were enrolled in the IDCT care management program; 148 were not enrolled.
• A second comparison group included 660 patients referred but not selected by the algorithm.
• Outcomes were evaluated 1-year post-intervention.

Main Results:

• IDCT program enrollees experienced reduced healthcare costs compared to non-enrollees (US$1,121.76 PMPM) and referral-only patients (US$1,625.61 PMPM).
• The program generated a net savings of US$1.9 million, exceeding its operational costs.
• These findings demonstrate significant cost-effectiveness in managing high-risk patient populations.

Conclusions:

• Interdisciplinary care teams (IDCT) effectively manage high-risk populations, leading to significant cost reductions.
• A novel selection algorithm enhances the cost-effectiveness of care management programs.
• Improved patient selection and team interdependence are key to successful high-risk patient management.