257236 Evaluation of a High Risk Case Management Pilot Program for Medicare Beneficiaries with Medigap Coverage

Monday, October 29, 2012 : 10:30 AM - 10:42 AM

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
Paula Parker, MBA, RN , Medicare & Retirement, UnitedHealth Group Alliances, Minneapolis, MN
Jinghua Huang, PhD , Advanced Analytics, OptumInsight, Ann Arbor, MI
Timothy Wells, MPH, PhD , Advanced Analytics, OptumInsight, Ann Arbor, MI
Richard J. Migliori, MD , Health Services, UnitedHealth Group Alliances, Minnetonka, MN
Charlotte S. Yeh, MD , AARP Services Inc., Washington, DC
Research Objective: To evaluate the second year experience of a High Risk Case Management (HRCM) pilot program.

Methods: Nurses and social workers provided in-person, telephonic, and mailed services to improve care coordination from 12/1/2008 to 12/31/2010. Adults (65+ years of age) who resided in one of five pilot states and who had a Hierarchical Condition Category score > 3.74, or were referred into the program were included in the analysis. This included 1,290 members who participated in the program, and 6,811 members who were qualified but did not participate.

Regression analyses were used to estimate healthcare savings and differences in quality of care metrics between engaged program members and similar non-engaged members. Quality of care metrics related to reduced hospital readmissions as well as Evidence Based Medicine (EBM) metrics were evaluated.

Results: Although not statistically significant, 63% of hospital readmission related metrics and 79% of EBM metrics showed engaged members received higher quality of care. The program showed an estimated savings of $1.5 million dollars, but was not statistically significant. Most of these savings were attributable to Medicare.

Conclusions: This study focuses on hospital readmission related metrics for a HRCM program designed solely for Medicare members with Medigap coverage. The HRCM program was associated with higher quality of care; however, the decrease in costs was not statistically significant in the second year of the program.

Learning Areas:
Administer health education strategies, interventions and programs
Biostatistics, economics
Planning of health education strategies, interventions, and programs
Public health or related research

Learning Objectives:
Describe the evaluation of a high risk case management program for older adults with Medigap insurance from a financial and quality of care perspective. Discuss analyses used and results of the second year of the program.

Keywords: Aging, Case Management

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Kevin R. Hawkins, Ph.D., Senior Research Director at OptumInsight, 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.
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.

Back to: 3102.0: Medicare/Medicaid Policy