Care Coordination for High-Need, High-Cost Commercially Insured Patients: A Randomized Clinical Trial

Area of Science:

• Health Services Research
• Healthcare Management
• Population Health

Background:

• High-need, high-cost (HNHC) patients comprise 5% of the US population but account for nearly half of all healthcare expenditures.
• Identifying effective interventions for this population is crucial for controlling rising healthcare costs.

Purpose of the Study:

• To evaluate the impact of a national telephonic care coordination program on healthcare cost and utilization among commercially insured HNHC patients.
• To determine if care coordination can reduce emergency department visits, hospitalizations, and overall healthcare spending.

Main Methods:

• A national, 2-arm randomized clinical trial involving 93,379 HNHC patients.
• Intervention group received telephonic care coordination by a registered nurse; control group received usual care.
• Intention-to-treat and instrumental variable analyses were conducted over a 12-month follow-up period.

Main Results:

• No statistically significant differences were observed between the intervention and control groups in mean monthly emergency department visits, inpatient hospitalizations, or total healthcare costs.
• Subgroup analyses, including patients with diabetes, also showed no significant reductions in utilization or cost.
• Instrumental variable analyses did not reveal evidence of improved outcomes with the care coordination intervention.

Conclusions:

• The national care coordination intervention did not lead to reductions in healthcare cost or acute care utilization among HNHC patients.
• The findings underscore the complexities and challenges in enhancing the efficiency of care for HNHC populations facing escalating costs.
• Further research is needed to identify effective strategies for managing this high-cost patient group.