Do payor-based outreach programs reduce medical cost and utilization?
Medicare
care management
congestive heart failure
continuity of care
health policy
high-risk patients
predictive analytics
Journal
Health economics
ISSN: 1099-1050
Titre abrégé: Health Econ
Pays: England
ID NLM: 9306780
Informations de publication
Date de publication:
06 2020
06 2020
Historique:
received:
09
02
2019
revised:
17
12
2019
accepted:
29
01
2020
pubmed:
13
2
2020
medline:
19
8
2021
entrez:
13
2
2020
Statut:
ppublish
Résumé
There is growing interest in using predictive analytics to drive interventions that reduce avoidable healthcare utilization. This study evaluates the impact of such an intervention utilizing claims from 2013 to 2017 for high-risk Medicare Advantage patients with congestive heart failure. A predictive algorithm using clinical and nonclinical information produced a risk score ranking for health plan members in 10 separate waves between July 2013 and May 2015. Each wave was followed by an outreach intervention. The varying capacity for outreach across waves created a set of arbitrary intervention treatment cutoff points, separating treated and untreated members with very similar predicted risk scores. We estimate a difference-in-differences model to identify the effects of the intervention program among patients with a high score on care utilization. We find that enrollment in the intervention decreased the probability and number of hospitalizations (by 43% and 50%, respectively) and emergency room visits (10% and 14%, respectively), reduced the time until a primary care visit (8.2 days), and reduced total medical cost by $716 per month in the first 6 months following outreach.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
671-682Informations de copyright
© 2020 John Wiley & Sons, Ltd.
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