A Novel Intervention for Medicaid Beneficiaries with Complex Needs

Area of Science:

• Health Services Research
• Public Health
• Healthcare Management

Background:

• Case management interventions show mixed results for patients with complex medical and social needs.
• Enhanced Care Management (ECM) is a key component of California's CalAIM initiative, designed for high-needs Medi-Cal members.

Purpose of the Study:

• To evaluate a novel intervention integrating ECM, telemedicine, and community-based social care.
• Assess the impact of this integrated model on patient engagement and health outcomes.

Main Methods:

• Retrospective cohort study of adult, ECM-eligible Medi-Cal members enrolled with Pair Team.
• Pre-post analyses compared one year of enrollment data with the prior year.
• Key metrics included program engagement, healthcare utilization, and mental health outcomes (PHQ-9).

Main Results:

• High patient engagement with the program (3.3 interactions/month) and healthcare providers.
• Significant increase in HbA1c and blood pressure monitoring post-enrollment.
• Reduced emergency department (52%) and inpatient visits (26%), with increased outpatient visits (21%).
• Mean PHQ-9 score decreased by 4.0 points, indicating improved mental health.

Conclusions:

• Patients receiving ECM services demonstrated high engagement in the program and their healthcare.
• The intervention led to decreased acute care utilization and reduced depressive symptoms.
• The Pair model shows potential for improving care delivery for individuals with complex health and social needs.