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Effect of Integrated Care Management Interventions on Post-hospitalization Utilization and Cost Outcomes for Adults
Mary Winger Knueven1, Yushu Liu2, Jane Kogan3
1UPMC Health Plan, Pittsburgh, PA, USA. wingerm2@upmc.edu.
Background:
A prior randomized trial assessed three care management (CM) interventions that were designed for adults at high risk of negative health outcomes following a hospital admission and implemented by a large health plan. These CM interventions positively and equivalently impacted several patient-centered outcomes over time.
Objective:
Use the prior randomized trial as the basis for testing post-hospitalization utilization and cost impacts (1) across three CM models (primary analysis) and (2) for each CM model (secondary analysis).
Design:
Post hoc comparison of three randomly assigned integrated CM interventions (IC) and a randomly selected, contemporaneous usual care control group (UC).
Participants:
Recently discharged high-risk Medicaid or dual-eligible Medicaid/Medicare members with multiple chronic conditions.
Interventions:
Three CM interventions: high-tech (4-12 months of remote patient monitoring with video visits/condition-specific texts and telephonic visits; n = 365); high-touch (4-12 months of telephonic visits; n = 335); optimal discharge planning (ODP; 2-4 weeks of telephonic visits; n = 149). All three included an initial in-person visit.
Main Measures:
Ninety-day readmission and emergency department (ED) visit rates; 12-month member care costs (total, medical, pharmacy).
Key Results:
UC had access to, but rarely used, traditional health plan CM. Compared to UC members (N = 886), IC members (N = 886) had similar total cost of care (p = 0.58). IC pharmacy costs trended 93.6% higher (p = 0.06) while medical costs trended 52.5% lower (p = 0.10), despite higher 90-day ED visit rates (IC 32.4% vs. UC 25.5% UC, p = 0.001) and no impact on 90-day readmission rate (IC 16.5% vs. UC 16.3%, p = 0.90). None of the three CM interventions showed an overall comparative advantage, despite some variations in their post-discharge utilization and cost impacts.
Conclusions:
The three post-discharge CM interventions tested showed promise as cost-neutral interventions within a large health plan setting. CM engagement may reduce medical cost specifically despite its impact on readmissions and ED use, though further evaluations of CM interventions are needed.
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Assessment