Xing Jingping, Goehring Candace, Mancuso David
Jingping Xing is a research investigator in the Research and Data Analysis Division, Washington State Department of Social and Health Services, in Olympia.
Candace Goehring is chief of the Office of Service Integration, Behavioral Health and Service Integration Administration, in the Washington State Department of Social and Health Services.
Health Aff (Millwood). 2015 Apr;34(4):653-61. doi: 10.1377/hlthaff.2014.0655.
Managing clinically complex populations poses a major challenge for state agencies trying to control health care costs and improve quality of care for Medicaid beneficiaries. In Washington State a care coordination intervention, the Chronic Care Management program, was implemented for clinically complex Medicaid beneficiaries who met risk criteria defined by a predictive modeling algorithm. We used propensity score matching to evaluate the program's impact on health care spending and utilization and mortality. We found large and significant reductions in inpatient hospital costs ($318 per member per month) among patients who used the program. The estimated reduction in overall medical costs of $248 per member per month exceeded the cost of the intervention but did not reach statistical significance. These results suggest that well-designed targeted care coordination services could reduce health care spending for Medicaid beneficiaries with complex health care needs.
对于试图控制医疗成本并提高医疗补助受益人的医疗质量的州机构而言，管理临床复杂人群是一项重大挑战。在华盛顿州，针对符合预测建模算法定义的风险标准的临床复杂医疗补助受益人实施了一项护理协调干预措施，即慢性病管理计划。我们使用倾向得分匹配法来评估该计划对医疗支出、医疗服务利用和死亡率的影响。我们发现，使用该计划的患者住院费用大幅显著降低（每人每月318美元）。估计每人每月总体医疗成本降低248美元，超过了干预成本，但未达到统计学显著性。这些结果表明，精心设计的针对性护理协调服务可以降低有复杂医疗需求的医疗补助受益人的医疗支出。
