To what extent can carefully targeted managed care programs for Medicare beneficiaries reduce costs for those awarded to Accountable Care Organizations (ACOs)? A new study showed significant results, but only with the most acute patients. These are the results of a study published in the June issue of Journal of Medical Research on the Internet (JMIR).
The article, “Impact Modeling for Reduced Medicare Responsible Care Organization Payments and Hospital Events in High-Cost Patients: A Longitudinal Cohort Study,” was written by a group of policy experts: Maureen A. Smith, Menggang Yu, Jared D. Huling, Xinyi Wang, Allie DeLonay, and Jonathan Jaffery.
As the authors write in the article, “We conducted a longitudinal cohort study of 76,140 patients in a Medicare lead care organization with multiple before and after measures of outcome, using linked electronic health records and Medicare claims data from 2012 to 2019. There were 489 patients in the historical case management program, with 1550 matched comparison patients, and 830 patients in the new program, with 2368 matched comparison patients. targeted high-risk patients and assigned a centrally located registered nurse and social worker to each patient.The new program targeted high- and moderate-risk patients and assigned a nurse physically located in a primary care clinic. judgment were all unforeseen hospital events (admissions, observation stays and emergency room visits), the n shadow of event days and Medicare payments.
The fundamental question: Could creating specific ‘benefit’ or ‘impactability’ scores for individual patients, using a method known as ‘impactability modeling’, make a difference in ensuring optimal level of care management and best outcomes? And would prospectively implementing the score and evaluating outcomes in a new case management program help care managers determine how well patients might respond to such carefully directed care management efforts?
So what happened? “In the historical program, as expected, high-benefit patients enrolled in case management had fewer events, fewer event days, and an average reduction of Medicare payments of US$1.15 million for 100 patients over the next year compared to matched test results Comparison patients For the new program, high-risk, high-benefit patients enrolled in case management had fewer events, while Moderate-risk high-benefit patients enrolled in case management did not differ from matched comparison patients.
The authors write that “although there was some evidence that a benefit score could be extended to a new case management program for similar (i.e., high-risk) patients, it is not There was no evidence that it could be extended to a moderate risk population. Scaling up a score to a new program and a new population should include assessment of program outcomes in key subgroups. With increased attention to value-based care, policymakers and measurement developers should consider ways to incorporate impactability modeling into program design and evaluation.
Maureen Smith, MD, MPH, Ph.D., is a professor of population health sciences and family medicine at the University of Wisconsin-Madison; Menggang Yu, Ph.D., is a professor of biostatistics and medical informatics in the Department of Statistics at the University of Wisconsin-Madison; Jared D. Huling, Ph.D., is an assistant professor in the Division of Biostatistics at the University of Minnesota School of Public Health; Xinyi Wang, MS, is a computational epidemiologist with the Washington State Department of Health (Seattle); Allie DeLonay, MS, is a data scientist at SAS in Madison, Wisconsin; and Jonathan Jaffery, MD, MS, is a faculty member in the Department of Medicine’s Division of Nephrology, and Director of Population Health at UW Health, and President of the UW Health ACO (Accountable Care Organization).