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Article Title

Impact of a Medically Complex Patient Care Model on Cost and Utilization Among Adolescents and Young Adults With Special Health Care Needs

Publication Date

8-15-2016

Keywords

medically complex, Medicaid

Abstract

Background/Aims: New evidence supports complex care management teams to improve outcomes and reduce costs for the small proportion of patients who account for a majority of health care expenditures. However, there is a lack of evidence specific to the adolescents and young adults with special health care needs in the transition age group, most of whom are covered by Medicaid. Geisinger has implemented a new care model –– the Comprehensive Care Clinic (CCC) –– focused on such patients. The CCC is comprised of a care team consisting of a super-generalist physician, advanced practitioner, pharmacist and a nurse case manager who provides close follow-up. Its clinical redesign includes advanced visit types, clinic hours for emergent situations and provider time outside of visits to coordinate interactions of the CCC team members with the patient, family caregiver and other health care providers. A central feature of the CCC is its reliance on a single care plan tailored to each patient to plan collaboratively for preventive and routine care as well as managing exacerbation and facilitating self-management education.

Methods: Geisinger Health Plan claims data covering a 19-month period ending September 31, 2014, were obtained for the 83 Medicaid patients enrolled in CCC as of April 2015, yielding 1,425 member-month observations. The dependent variables were total expenditure (allowed amounts including prescription drugs) and acute care utilization (inpatient admissions and emergency room [ER] visits). The key explanatory variable was an indicator for whether the member was enrolled in CCC in a given month of the study period. Multivariate regression models with patient fixed effects were estimated to obtain adjusted differences in cost and utilization between months in which the patients were enrolled and not enrolled in the CCC.

Results: CCC enrollment was associated with 28% reduction in per-member-per-month total cost ($3,931 observed vs. $5,451 expected, P = 0.028), driven by large reductions in acute inpatient admissions and ER visits.

Conclusion: A clinical redesign involving longer visits, clinic time for emergent needs, a coordinated care plan and a partnership among super generalists, nurse care manager and pharmacists can potentially reduce total cost and acute care utilization during transition from pediatrics to adult medicine.

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