A Randomized Controlled Trial of Intensive Care Management for Disabled Medicaid Beneficiaries with High Health Care Costs. (26th November 2014)

• Record Type: Journal Article
• Authors: Bell, Janice F.; Krupski, Antoinette; Joesch, Jutta M.; West, Imara I.; Atkins, David C.; Court, Beverly; Mancuso, David; Roy‐Byrne, Peter
• Is Part Of: Health services research. Volume 50:Number 3(2015)
• Page Start: 663
• Page End: 689
• Publication Date: 2014-11-26
• Subjects: Medical care -- Periodicals; Medical care -- Evaluation -- Periodicals; Hospital care -- Periodicals; Health services administration -- Periodicals; 362
• DOI: 10.1111/1475-6773.12258
• Languages: English
• ISSNs: 0017-9124

Abstract

<abstract abstract-type="main" id="hesr12258-abs-0001"> <title> <x xml:space="preserve">Abstract</x> </title> <sec id="hesr12258-sec-0001" sec-type="section"> <title>Objective</title> <p>To evaluate outcomes of a registered nurse–led care management intervention for disabled Medicaid beneficiaries with high health care costs.</p> </sec> <sec id="hesr12258-sec-0002" sec-type="section"> <title>Data Sources/Study Setting</title> <p>Washington State Department of Social and Health Services Client Outcomes Database, 2008–2011.</p> </sec> <sec id="hesr12258-sec-0003" sec-type="section"> <title>Study Design</title> <p>In a randomized controlled trial with intent‐to‐treat analysis, outcomes were compared for the intervention (<italic>n</italic> = 557) and control groups (<italic>n</italic> = 563). A quasi‐experimental subanalysis compared outcomes for program participants (<italic>n</italic> = 251) and propensity score‐matched controls (<italic>n</italic> = 251).</p> </sec> <sec id="hesr12258-sec-0004" sec-type="section"> <title>Data Collection/Extraction Methods</title> <p>Administrative data were linked to describe costs and use of health services, criminal activity, homelessness, and death.</p> </sec> <sec id="hesr12258-sec-0005" sec-type="section"> <title>Principal Findings</title> <p>In the intent‐to‐treat analysis, the intervention group had higher odds of outpatient mental health service use and higher prescription drug costs than controls in the postperiod. In the subanalysis, participants had fewer unplanned hospital admissions and lower associated costs; higher prescription drug costs; higher odds of long‐term care service use; higher drug/alcohol treatment costs; and lower odds of homelessness.</p> </sec> <sec id="hesr12258-sec-0006" sec-type="section"> <title>Conclusions</title> <p>We found no health care cost savings for disabled Medicaid beneficiaries randomized to intensive care management. Among participants, care management may have the potential to increase access to needed care, slow growth in the number and therefore cost of unplanned hospitalizations, and prevent homelessness. These findings apply to start‐up care management programs targeted at high‐cost, high‐risk Medicaid populations.</p> </sec> </abstract>