More seniors are joining health maintenance organizations (HMOs) and many of them have chronic illnesses and other risk factors leading to adverse health outcomes and high utilization of health resources. This study designs a health risk assessment (HRA) system for new Medicare+Choice members and measures effectiveness of HRA. A total of 23,226 new Medicare+ Choice members received an HRA questionnaire between September 1998 and April 1999. Each individual member's risk score and detail-level report was sent to his/her PCP for evaluation. Two hypotheses were tested: HRA participants had better outcomes than non-participants; new members electing a new primary care physician (PCP) requires more health services than those retaining their existing PCP. The return rate was 78%. 57% were female, 32% were aged 75 or older, 18% rated their health as fair or poor, 68% reported one or more chronic conditions. Based on 4 months of follow-up claims data, HRA participants had statistically significant higher eye exam, pneumonia immunization, and mammogram screening rates compared to members who did not participate in the HRA program. HRA participants had 27% lower inpatient costs and 20% lower overall medical costs. Significant differences were found between two groups (new PCPs vs existing PCPs) for the following items: in the past 12 months, members selected new PCPs had fewer preventive screenings but higher risks on lifestyle behaviors and more hospital admissions. Four months after the HRA and member education initiatives, members with new PCPs had lower inpatient costs.
Learning Objectives: After the session, the participants will be able to: 1. Understand Medicare+Choice members enrolled into managed care with certain high health risk factors; 2. List three risk factors that link a health behavior to healthy outcomes; 3. Learn benefits from health risk assessment and cost impact by early intervention
Keywords: Risk Assessment, Medicare
Presenting author's disclosure statement:
Organization/institution whose products or services will be discussed: Tufts Health Plan
I have a significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.
Relationship: employment