235234 Hospital-Related Quality of Care Improvements Associated with a High Risk Case Management Pilot Program for Medicare Members with Medigap Coverage

Tuesday, November 1, 2011

Kevin Hawkins, PhD , Advanced Analytics, OptumInsight, Ann Arbor, MI
Ronald J. Ozminkowski, PhD , Advanced Analytics, OptumInsight, Ann Arbor, MI
Gandhi R. Bhattarai, PhD , Advanced Analytics, OptumInsight, Rocky Hill, CT
Shaohung Wang, PhD , Health Care Innovation and Information, Ingenix, Rocky Hill, CT
Paula Parker, MBA, RN , Medicare & Retirement, UnitedHealth Group Alliances, Minneapolis, MN
Cynthia Barnowski, MBA, MS, RN , UnitedHealth Group Alliances, Minnetonka, MN
Richard J. Migliori, MD , Health Services, UnitedHealth Group Alliances, Minnetonka, MN
Charlotte S. Yeh, MD , AARP Services Inc., Washington, DC
Seth Serxner, PhD, MPH , Mercer, Los Angeles, CA
Research Objective: Estimate the relationship between participation in a High Risk Case Management (HRCM) program and inpatient hospital-related quality of care for Medicare beneficiaries with an AARP® Medicare Supplement (i.e. Medigap) plan insured by UnitedHealthcare Insurance Company or UnitedHealthcare Insurance Company of New York. Study Design: In-home and telephone HRCM services were provided by nurses and social workers to improve care coordination for those with multiple chronic conditions. Propensity-score-weighted regression analyses were used to estimate associations between HRCM participation and three inpatient, hospital-related quality of care metrics: having one or more visits with a doctor within 15 days of a hospital discharge, fewer readmissions within 30 days of a hospital discharge, and lower average inpatient hospital expenditures. Population Studied: Sample members resided in five pilot states. Those who qualified for the program had Hierarchical Condition Category scores greater than 3.74. 676 members voluntarily participated in the program. 5,654 similar members were used for comparison. Results: After adjusting for demographic and health status differences, HRCM participants were significantly (3.7%, p=0.05) more likely to have an office visit within 15 days of a hospital discharge, significantly less likely (28.1% p=0.07) to have a hospital readmission within 30 days of hospital discharge, and averaged significantly fewer inpatient hospital expenditures per month ($37.28, p=0.01). In addition, almost all members (98%) were satisfied with the program. Conclusions: This is the first known HCRM program designed for Medigap members. It was associated with high member satisfaction and better hospital-related quality of care in its first year.

Learning Areas:
Administer health education strategies, interventions and programs
Chronic disease management and prevention
Conduct evaluation related to programs, research, and other areas of practice

Learning Objectives:
Evaluate the relationship between participation in a High Risk Case Management (HRCM) program and inpatient hospital-related quality of care for older adults with Medigap insurance.

Keywords: Quality of Care, In-Home Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Kevin R. Hawkins, Ph.D., Senior Director at Ingenix has over 20 years experience designing, conducting, and managing health services research. Dr. Hawkins has conducted a variety of research and evaluation projects, specifically health-economic, quality-of-life, disease burden, pharmacoeconomics and retrospective database analyses. Dr. Hawkins has authored over 40 peer-reviewed articles and presentations, and is a reviewer for several medical-scientific journals. Before joining Ingenix, Dr. Hawkins worked for IMS Health, Medstat, and Blue Cross Blue Shield of Michigan. Dr. Hawkins received his Ph.D. in Health Economics from Wayne State University. I contributed substantially to the planning and evaluation of the submitted work.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.