235252 Return on Investment Associated with a High Risk Case Management Pilot Program for Medicare Beneficiaries 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 return on investment (ROI) associated with participation in a pilot High Risk Case Management (HRCM) program 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 multiple regression analyses were used in a difference-in-difference framework to estimate savings in total healthcare expenditures per engaged participant per month that were associated with program participation. ROI was estimated as monthly savings divided by monthly costs of the program. Population Studied: Those who qualified for the program resided in five pilot states with Hierarchical Condition Category scores greater than 3.74. 676 members voluntarily participated in the program. 5,654 similar insureds were used for comparison. Results: The ROI showed favorable savings ($2.18 per dollar spent on the program). These savings primarily accrued to Medicare, which paid about 84% of total healthcare expenditures. To a lesser extent savings accrued to the Medigap payer and to members, who paid 7% and 9% of total expenditures, respectively. Almost all members (98%) were satisfied with the program. Conclusions: This is the first known HCRM program designed solely for Medigap members. While its ROI estimate was not statistically significant (p=0.65) in the first year, these results are encouraging for a pilot program. As the program continues to expand, continued member satisfaction and statistically significant results are anticipated.

Learning Areas:
Administration, management, leadership
Biostatistics, economics
Planning of health education strategies, interventions, and programs
Program planning

Learning Objectives:
Assess the return on investment for a pilot High Risk Case Management (HRCM) program for older adults with Medigap insurance.

Keywords: Case Management, Economic Analysis

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.