Personalized care for complex lives: initial outcomes of a behaviorally-informed complex care intervention

Area of Science:

• Healthcare Management
• Behavioral Health
• Health Economics

Background:

• High-cost patients (5%) drive substantial healthcare spending.
• Standardized interventions often fail to yield a return on investment for this population.
• Medically high-risk individuals with behavioral health diagnoses require tailored management strategies.

Purpose of the Study:

• To develop and demonstrate an adaptive intervention for medically high-risk patients.
• To reduce healthcare costs and readmission risk in individuals with behavioral health conditions.
• To evaluate the return on investment of personalized care services.

Main Methods:

• A behaviorally-oriented, personalized care service was implemented using a multidisciplinary team.
• The service involved iterative, tailored treatment approaches to prevent decompensation and retrain behaviors.
• A matched case-control study compared 26 intervention members with 26 controls from an employee health plan.

Main Results:

• Significant decreases in both planned and unplanned medical expenditures were observed for high utilizers (n=7).
• Unplanned healthcare expenditures significantly decreased for standard utilizers (n=19).
• Readmission risk scores decreased significantly for standard utilizers, but not for high utilizers.

Conclusions:

• A behaviorally-oriented personalized care intervention demonstrated value in a commercial insurance population.
• The intervention led to decreased healthcare spend for high utilizers and reduced readmission risk for standard utilizers.
• Further expansion, refinement, and evaluation of this adaptive intervention are recommended.