Innovations in Medicaid: Impacts of a Home-Based Intensive Care Model for Complex Medicaid Beneficiaries
Adapting a Model of Integrated and In-Home Care to Serve Medicaid Patients with Multiple Chronic Conditions
California Health Care Foundation
- A primary goal of the intensive care model was to reduce ED visits and inpatient stays. Evidence suggests that the intervention successfully reduced ED visits and inpatient stays, driven by reductions in visits with an associated behavioral health diagnosis.
- The intensive care model was associated with higher use of primary care overall, and a much higher probability of a follow-up visit with a primary care provider within 30 days of hospital discharge, an expected result because the intervention prioritized patients recently discharged from the hospital.
- Effects were particularly strong for members with behavioral health diagnoses at baseline. Members with behavioral health diagnoses at baseline experienced a decrease in ED visits and increase in outpatient visits that was at least as large if not larger than members without a documented behavioral health diagnosis.
Effectively managing care for individuals with complex health care needs has the potential to both improve health care quality and reduce costs, but relatively few models have been implemented in a Medicaid population. The California Health Care Foundation (CHCF) invested in an innovative care delivery model by supporting a partnership between Landmark Health and two California Medicaid managed care health plans. Building on the model it developed for Medicare Advantage populations outside California, Landmark delivered coordinated home-based services, including on-demand clinical care and connections to social services, to two cohorts of high-risk Medicaid managed care members with multiple medical or behavioral health needs, many of whom were also dually eligible for Medicare. To understand the impacts of the model and to identify lessons learned in adapting the model to serve Medicaid enrollees, CHCF contracted with Mathematica to evaluate the initial implementation of the model from 2016 to 2018. We found that Landmark’s home-based intensive care model accomplished many of its goals by changing patterns of health care use for engaged members. The model was associated with statistically significant decreases in ED visits and inpatient stays with an associated behavioral health diagnosis, increases in primary care visits, and increased rates of follow-up after discharge from inpatient and skilled nursing facility stays. Together with findings from other programs, our findings support the idea that providing coordinated home-based services that include a behavioral health component and address patients’ unmet social needs can meaningfully reduce acute care spending.