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

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.