Effects of a Community-Based Care Management Model for Super Utilizers

Effects of a Community-Based Care Management Model for Super Utilizers

Published: Nov 05, 2018
Publisher: The American Journal of Managed Care, vol. 24, no. 11
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Associated Project

HCIA Evaluations: Primary Care Redesign

Time frame: 2013-2017

Prepared for:

U.S. Department of Health and Human Services, Centers for Medicare & Medicaid Services

U.S. Department of Health and Human Services, Center for Medicare & Medicaid Innovation

Authors

Cara N. Stepanczuk

Katharine W.V. Bradley

Tim Day

Greg Peterson

Kate Stewart

Lorenzo Moreno

Objectives

Medicare, Medicaid, and commercial plans have all explored ways to improve outcomes for patients with high costs and complex medical and social needs. The purpose of this study was to test the effectiveness of a high-intensity care management program that the Rutgers University Center for State Health Policy (CSHP) implemented as an adaptation of a promising model developed by the Camden Coalition of Healthcare Providers.

Study Design

The authors estimated the impact of the program on 6 utilization and spending outcomes for a subgroup of beneficiaries enrolled in Medicare fee-for-service (n = 149) and a matched comparison group (n = 1130).

Methods

The authors used Medicare claims for all analyses. We used propensity score matching to construct a comparison group of beneficiaries with baseline characteristics similar to those of program participants. We employed regression models to test the relationship between program enrollment and outcomes over a 12-month period while controlling for baseline characteristics.

Results

A test of joint significance across all outcomes showed that the CSHP program reduced service use and spending in aggregate (P = .012), although estimates for most of the individual measures were not statistically significant. Participants had 37% fewer unplanned readmissions (P = .086) than did comparison beneficiaries. Although we did not find statistically significant results for the other 5 outcomes, the CIs for these outcomes spanned substantively large effects.

Conclusions

Although these findings are mixed, they suggest that adaptations of the Camden model hold promise for reducing short-term service use and spending for Medicare super utilizers.

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