Dataset Information

A Novel Intervention for High-Need, High-Cost Medicaid Patients: a Study of ECHO Care.

ABSTRACT:

Background

A small number of high-need patients account for a disproportionate amount of Medicaid spending, yet typically engage little in outpatient care and have poor outcomes.

Objective

To address this issue, we developed ECHO (Extension for Community Health Outcomes) Care™, a complex care intervention in which outpatient intensivist teams (OITs) provided care to high-need high-cost (HNHC) Medicaid patients. Teams were supported using the ECHO model™, a continuing medical education approach that connects specialists with primary care providers for case-based mentoring to treat complex diseases.

Design

Using an interrupted time series analysis of Medicaid claims data, we measured healthcare utilization and expenditures before and after ECHO Care.

Participants

ECHO Care served 770 patients in New Mexico between September 2013 and June 2016. Nearly all had a chronic mental illness, and over three-quarters had a chronic substance use disorder.

Intervention

ECHO Care patients received care from an OIT, which typically included a nurse practitioner or physician assistant, a registered nurse, a licensed mental health provider, and at least one community health worker. Teams focused on addressing patients' physical, behavioral, and social issues.

Main measures

We assessed the effect of ECHO Care on Medicaid costs and utilization (inpatient admissions, emergency department (ED) visits, other outpatient visits, and dispensed prescriptions.

Key results

ECHO Care was associated with significant changes in patients' use of the healthcare system. At 12 months post-enrollment, the odds of a patient having an inpatient admission and an ED visit were each reduced by approximately 50%, while outpatient visits and prescriptions increased by 23% and 8%, respectively. We found no significant change in overall Medicaid costs associated with ECHO Care.

Conclusions

ECHO Care shifts healthcare utilization from inpatient to outpatient settings, which suggests decreased patient suffering and greater access to care, including more effective prevention and early intervention for chronic conditions.

SUBMITTER: Komaromy M

PROVIDER: S-EPMC6957626 | biostudies-literature | 2020 Jan

REPOSITORIES: biostudies-literature

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Publications

A Novel Intervention for High-Need, High-Cost Medicaid Patients: a Study of ECHO Care.

Komaromy Miriam M Bartlett Judy J Gonzales-van Horn Sarah R SR Zurawski Andrea A Kalishman Summers G SG Zhu Yiliang Y Davis Herbert T HT Ceballos Venice V Sun Xi X Jurado Martin M Page Kimberly K Hamblin Allison A Arora Sanjeev S

Journal of general internal medicine 20191030 1

<h4>Background</h4>A small number of high-need patients account for a disproportionate amount of Medicaid spending, yet typically engage little in outpatient care and have poor outcomes.<h4>Objective</h4>To address this issue, we developed ECHO (Extension for Community Health Outcomes) Care™, a complex care intervention in which outpatient intensivist teams (OITs) provided care to high-need high-cost (HNHC) Medicaid patients. Teams were supported using the ECHO model™, a continuing medical educa ...[more]

PMID: 31667743

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Project description:BackgroundMany health systems have implemented team-based programs to improve transitions from hospital to home for high-need, high-cost patients. While preliminary outcomes are promising, there is limited evidence regarding the most effective strategies.ObjectiveTo determine the effect of an intensive interdisciplinary transitional care program emphasizing medication adherence and rapid primary care follow-up for high-need, high-cost Medicaid and Medicare patients on quality, outcomes, and costs.DesignQuasi-experimental study.PatientsAmong 2235 high-need, high-cost Medicare and Medicaid patients identified during an index inpatient hospitalization in a non-profit health care system in a medically underserved area with complete administrative claims data, 285 participants were enrolled in the SafeMed care transition intervention, and 1950 served as concurrent controls.InterventionsThe SafeMed team conducted hospital-based real-time screening, patient engagement, enrollment, enhanced discharge care coordination, and intensive home visits and telephone follow-up for at least 45 days.Main measuresPrimary difference-in-differences analyses examined changes in quality (primary care visits, and medication adherence), outcomes (preventable emergency visits and hospitalizations, overall emergency visits, hospitalizations, 30-day readmissions, and hospital days), and medical expenditures.Key resultsAdjusted difference-in-differences analyses demonstrated that SafeMed participation was associated with 7% fewer hospitalizations (- 0.40; 95% confidence interval (CI), - 0.73 to - 0.06), 31% fewer 30-day readmissions (- 0.34; 95% CI, - 0.61 to - 0.07), and reduced medical expenditures ($- 8690; 95% CI, $- 14,441 to $- 2939) over 6 months. Improvements were limited to Medicaid patients, who experienced large, statistically significant decreases of 39% in emergency department visits, 25% in hospitalizations, and 79% in 30-day readmissions. Medication adherence was unchanged (+ 2.6%; 95% CI, - 39.1% to 72.9%).ConclusionsCare transition models emphasizing strong interdisciplinary patient engagement and rapid primary care follow-up can enable health systems to improve quality and outcomes while reducing costs among high-need, high-cost Medicaid patients.

Project description:INTRODUCTION:Segmentation of the high-need, high-cost (HNHC) population is required for reorganizing care to accommodate person-centered, integrated care delivery. Therefore, we aimed to identify and characterize relevant subgroups of the HNHC population in primary care by using demographic, biomedical, and socioeconomic patient characteristics. METHODS:This was a retrospective cohort study within a Dutch primary care group, with a follow-up period from September 1, 2014 to August 31, 2017. Chronically ill patients were included in the HNHC population if they belonged to the top 10% of care utilizers and/or suffered from multimorbidity and had an above-average care utilization. In a latent class analysis, forty-one patient characteristics were initially used as potential indicators of heterogeneity in HNHC patients' needs. RESULTS:Patient data from 12 602 HNHC patients was used. A 4-class model was considered statistically and clinically superior. The classes were named according to the characteristics that were most dominantly present and distinctive between the classes (i.e. mainly age, household position, and source of income). Class 1 ('older adults living with partner') included 39.3% of patients, class 2 ('older adults living alone') included 25.5% of patients, class 3 ('middle-aged, employed adults with family') included 23.3% of patients, and class 4 ('middle-aged adults with social welfare dependency') included 11.9% of patients. Diabetes was the most common condition in all classes; the second most prevalent condition differed between osteoarthritis in class 1 (21.7%) and 2 (23.8%), asthma in class 3 (25.3%), and mood disorders in class 4 (23.1%). Furthermore, while general practitioner (GP) care utilization increased during the follow-up period in the classes of older adults, it remained relatively stable in the middle-aged classes. CONCLUSIONS:Although the HNHC population is heterogeneous, distinct subgroups with relatively homogeneous patterns of mainly demographic and socioeconomic characteristics can be identified. This calls for tailoring care and increased attention for social determinants of health.

Dataset Information

A Novel Intervention for High-Need, High-Cost Medicaid Patients: a Study of ECHO Care.

Background

Objective

Design

Participants

Intervention

Main measures

Key results

Conclusions

Publications

A Novel Intervention for High-Need, High-Cost Medicaid Patients: a Study of ECHO Care.

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