How much can a carefully targeted care management program for Medicare beneficiaries reduce the cost of what is attributed to an accountable care organization (ACO)? New studies show important results, but only for the most sensitive patients. These are the results of a study published in the June issue. Journal of Medical Internet Research (JMIR)..
The article “Impact Modeling for Reducing Medicare Accountable Care Organization Payments and Hospital Events in Highly Costing Patients: Longitudinal Cohort Study” was written by a group of policy makers: Maureen A. Smith, Menggang Yu, Jared D. Huling, Xinyi Wang, Allie DeLonay, and Jonathan Jaffery.
As the author writes in the article, “We are responsible for Medicare with multiple pre- and post-measures of results using linked electronic health records and Medicare billing data from 2012 to 2019. We conducted a longitudinal cohort study of 76,140 patients from a care organization. The previous case management program had 489 patients, 1550 consistent comparative patients, and the new program 830 patients. There were 2368 matched comparative patients. The historic program targeted high-risk patients and assigned centralized registered nurses and social workers to each patient. The new program Our main achievements were unplanned hospital events (hospitalization, observational stays, emergency departments), targeting high-risk and medium-risk patients and assigning physically assigned nurses to the primary care clinic. Visits), event days, and Medicare payments. “
Basic question: Optimal level of care management and best results by creating a specific “benefit” or “impact” score for each individual patient using a method called “impact modeling” Can you make a difference in terms of securing? And by positively implementing scores and assessing results with a new case management program, care managers can determine how well patients can respond to such carefully directed care management efforts. Will it help?
what happened? “In the historic program, as expected, high-margin patients enrolled in case management have fewer events, fewer event days, and Medicare payments per 100 patients the following year, compared to consistent results. Average US $ 1.15 million decreased. Comparative patients. In the new program, high-margin, high-risk patients enrolled in case management had fewer events, while high-margin, medium-risk patients enrolled in case management responded. It was no different from the comparative patient. “
The authors state that: “There was evidence that the benefit score could be extended to a new case management program for similar (ie, high-risk) patients, but there was no evidence that the score could be extended to a new program and population. To extend to, it is necessary to include an assessment of the outcome of the program within key subgroups. With increasing focus on value-based care, policy makers and measurement developers are designing their programs for influence modeling. And how to incorporate it into the evaluation. “
Maureen Smith, MD, MPH, Ph.D. is a professor of artificial health sciences and home medicine at the University of Wisconsin-Madison. Menggang Yu, Ph.D. is a professor of biostatistics and medical informatics at the University of Wisconsin-Madison School of Statistics. Jared D. Huling, Ph.D. is an assistant professor of biostatistics at the University of Minnesota School of Public Health. Xinyi Wang, MS, is an informatics epidemiologist at the Washington State Department of Health (Seattle). Allie DeLonay, MS, is a SAS data scientist in Madison, Wisconsin. Jonathan Jaffery, MD, MS is a faculty member of the Department of Nephrology, School of Medicine, Chief Population Health Officer of UW Health, and President of UW Health ACO (Accountable Care Organization).
