BY CHRISTOPHER CHENEY |
FEBRUARY 25, 2020
CareMore Health's care
management program in Tennessee has multidisciplinary care teams with community
health workers, primary care providers, and social workers.
KEY
TAKEAWAYS
Compared to patients
receiving usual care, CareMore Health's "hotspotting" program reduced
total medical expenditures by $7,732 per member per year.
The primary drivers of
the spending reduction were lower inpatient utilization, with bed days reduced
by 59% and inpatient admissions decreased by 44%.
The care management
program had four keys to success such as targeting patients with "rising
risk" rather than historical "superutilizers."
A care management program in Tennessee for
high-need, high-cost Medicaid patients reduces healthcare service spending and
healthcare utilization, research published
this month indicates.
"Superutilizer" patients account for a
disproportionate share of healthcare spending in the United States, with earlier research finding
that 5% of the country's population accounts for 50% of annual healthcare
expenditures. A study published
last month by New England Journal of Medicine stirred
controversy about care management programs for superutilizer patients—finding
that the Camden Coalition of Healthcare Providers "hotspotting" program did not reduce
hospital readmissions.
The research published this month, which appears
in American Journal of Managed Care, features a care management
program for Medicaid patients conducted by CareMore Health in Memphis,
Tennessee. The lead author of the CareMore research told HealthLeaders that
the NEJM study is a reminder that there is no silver bullet
for hotspotting, but he said care management for complex patients should
continue.
"The results from our evaluation of
CareMore’s complex care management program suggest that carefully designed and
targeted programs can improve care and reduce spending for high-need, high-cost
patients. Hopefully, this results in a more optimistic view on the potential of
hotspotting, and spurs continued work to develop care models that better serve
our most complex patients," said Brian Powers, MD, MBA, director of
population health strategy and analytics at CareMore.
CAREMORE
RESEARCH DATA
The CareMore care management program was staffed
with a multidisciplinary team including a community health
worker, a social worker, and a primary care provider.
The community health worker conducted patient
accompaniment, activation, engagement, and outreach. The social worker
conducted counseling and brief interventions for patients with behavioral
health needs and coordinated referrals to social service agencies and other
medical providers. The PCP conducted comprehensive care for acute and chronic
conditions as well as coordination with specialists and inpatient clinicians.
The CareMore research examined data collected from
nearly 200 Medicaid patients, with 71 assigned to the care management program
and 127 assigned to usual care over a year-long period. The research includes
several key data points:
·
Compared to patients
receiving usual care, care management program patients had significantly lower
total medical expenditures ($7,732 lower per member per year)
·
Care management program
patients had 3.46 fewer inpatient bed days per member per year
·
Care management program
patients had 1.35 fewer specialist visits per member per year
"A complex care management program reduced
spending and inpatient utilization among high-need, high-cost Medicaid
patients. Patients randomized to complex care management had [total medical
expenditures] that were 37% lower than those randomized to usual care, an
absolute reduction of $7,732 per patient per year. This spending reduction
appeared to be driven primarily by decreases in inpatient utilization—bed days
were reduced by 59% and admissions by 44%," Powers and his co-authors wrote.
KEYS
TO CARE MANAGEMENT SUCCESS
Powers told HealthLeaders that
CareMore's hotspotting program has four essential elements.
·
Target
the right patients: CareMore's care
management program used predictive models, claims data, clinical criteria, and
clinician judgment to identify "rising risk" populations and those
most likely to benefit from complex care management, rather than focusing on
historical "superutilizers" whose care needs and spending often
regress to the mean.
·
Incorporate
non-traditional healthcare staff such as community health workers: CareMore's hotspotting program underscored
the important role that community-based, non-medical team members play in
engaging patients, building trust, and better understanding and managing the
non-medical drivers of poor outcomes. For example, the community health worker
served as an engagement specialist, creating a safe and welcoming environment
for patients and utilizing their training to increase patient motivation and
activation. The community health worker also functioned as the engaged family
member that many patients lacked.
·
Integrate
within the clinical team: The
care management program was built into an existing medical home model. This
removed barriers for collaboration and coordination between the community
health worker, social worker, and primary care physician. It also allowed the
care team to simultaneously address the medical and non-medical drivers of poor
outcomes, rather than approaching each in a siloed fashion.
·
Focus
on the most impactable drivers of poor outcomes: The hotspotting program tailored complex
care management to the needs of individual patients rather than using a
one-size-fits-all approach. For each patient, the care team identified and
prioritized patients' unique drivers of poor health and high costs, with a
focus on the drivers that mattered most to the patient and those that could be
addressed over the course of weeks and months. This was essential for improving
efficacy and efficiency.
Christopher Cheney is the senior clinical care editor at
HealthLeaders.
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