Harvard Medical School, 75 Francis St, Boston, MA 02446. Email:
Am J Manag Care. 2020 Feb 1;26(2):e57-e63. doi: 10.37765/ajmc.2020.42402.
Complex care management programs have emerged as a promising model to better care for high-need, high-cost patients. Despite their widespread use, relatively little is known about the impact of these programs in Medicaid populations. This study evaluated the impact of a complex care management program on spending and utilization for high-need, high-cost Medicaid patients.
Randomized quality improvement trial conducted at CareMore Health in Memphis, Tennessee. A total of 253 high-need, high-cost Medicaid patients were randomized in a 1:2 ratio to complex care management or usual care.
Intention-to-treat analysis compared regression-adjusted rates of spending and utilization between patients randomized to the complex care program (n = 71) and those randomized to usual care (n = 127) over the 12 months following randomization. Primary outcomes included total medical expenditures (TME) and inpatient (IP) days. Secondary outcomes included IP admission, emergency department (ED) visits, care center visits, and specialist visits.
Compared with patients randomized to usual care, patients randomized to complex care management had lower TME (adjusted difference, -$7732 per member per year [PMPY]; 95% CI, -$14,914 to -$550; P = .036), fewer IP bed days (adjusted difference, -3.46 PMPY; 95% CI, -4.03 to -2.89; P <.001), fewer IP admissions (adjusted difference, -0.32 PMPY; 95% CI, -0.54 to -0.11; P = .014), and fewer specialist visits (adjusted difference, -1.35 PMPY; 95% CI, -1.98 to -0.73; P <.001). There was no significant impact on care center or ED visits.
Carefully designed and targeted complex care management programs may be an effective approach to caring for high-need, high-cost Medicaid patients.
复杂的护理管理方案已成为一种有前途的模式，可以更好地为高需求、高费用的患者提供护理。尽管这些方案得到了广泛应用，但对于这些方案在医疗补助人群中的影响，人们知之甚少。本研究评估了一种复杂的护理管理方案对高需求、高费用的医疗补助患者的支出和利用的影响。
在田纳西州孟菲斯的 CareMore Health 进行的一项随机质量改进试验。总共将 253 名高需求、高费用的医疗补助患者以 1:2 的比例随机分为复杂护理管理组（n = 71）和常规护理组。
意向治疗分析比较了随机分组至复杂护理方案的患者（n = 71）与随机分组至常规护理的患者（n = 127）在随机分组后 12 个月内的支出和利用回归调整率。主要结局包括总医疗支出（TME）和住院（IP）天数。次要结局包括 IP 入院、急诊就诊、护理中心就诊和专科就诊。
与随机分组至常规护理的患者相比，随机分组至复杂护理管理的患者 TME 较低（调整差异，-7732 美元/人/年[PMPY]；95%CI，-14914 美元至-550 美元；P =.036），住院天数较少（调整差异，-3.46 PMPY；95%CI，-4.03 美元至-2.89 美元；P <.001），住院次数较少（调整差异，-0.32 PMPY；95%CI，-0.54 美元至-0.11 美元；P =.014），专科就诊次数较少（调整差异，-1.35 PMPY；95%CI，-1.98 美元至-0.73 美元；P <.001）。护理中心或急诊就诊无显著影响。
精心设计和有针对性的复杂护理管理方案可能是一种有效治疗高需求、高费用医疗补助患者的方法。
