Return on Investment Associated with a High Risk Case Management Pilot Program for Medicare Beneficiaries with Medigap Coverage

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.