Care coordination yields limited healthcare savings
Researchers have compared reductions in healthcare expenditure and utilization amongst chronic disease patients who received coordinated care compared to standard care. The results suggest that coordinated care is no more effective at lowering Medicaid spending than standard care.
In 2014, researchers from the University of Illinois at Chicago (UIC; IL, USA) initiated a novel project – entitled Coordinated Healthcare for Complex Kids (CHECK) – devising and testing a comprehensive, care coordination program for Medicaid-insured children and young people with chronic health conditions. Initial results of a comparative effectiveness trial, evaluating the benefits of the coordinated care scheme compared to standard care, demonstrate that coordinated care delivery is as effective at lowering Medicaid spending as standard care.
In the study, researchers analyzed Illinois Medicaid paid claims data of 6259 patients from 2014–2017. 3126 study participants had prospectively been randomized to receive coordinated care; the remaining individuals who participated in the study functioned as a standard care-receiving control group. Researchers compared healthcare costs and utilization – including emergency room visits and hospitalizations – between the coordinated and standard care-receiving patient cohorts.
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Over the course of the study, healthcare utilization of both patient cohorts decreased significantly; for example, inpatient hospitalizations of both groups decreased by approximately 30%.
Further, the mean healthcare costs of coordinated care-receiving patients dropped from US$1633 to US$1341. This reduction is of a similar magnitude to the decrease in healthcare spending observed for control group patients. Spending in this latter cohort dropped from US$1703 to US$1413 over the course of the study.
Senior study author Benjamin Van Voorhees, Director of the CHECK project, commented: “We set out to demonstrate the feasibility of a large-scale care coordination model for a pediatric population, and by blending use of community health workers and social work professionals with health information technology, we've accomplished that…while this data is not what we expected, it will help us refine the program.”
Van Voorhees continued: “During the year of this study, newly introduced managed Medicaid plans likely played a role in reductions of health care expenditures in both groups, making the comparison between the two groups more complicated than anticipated…Cost is an important part of the CHECK story, but it is not its complete story. This study gets us a step closer to understanding where and how care coordination is most effective.”
Rachel Caskey, first study author and associate professor of medicine and pediatrics at the College of Medicine at UIC, explained: “Though the first year of CHECK did not appear to impact Medicaid expenditures, we know that care coordination programs for children have many intangible benefits to participants and family members that may take years to appreciate and fully measure. 1 year is likely not long enough to fully appreciate the impact of CHECK. As we continue analyzing the data, we may find additional cost reductions the longer children are enrolled in the program. Or, we may find that there are other benefits.”
Caskey R, Moran K, Touchette D et al. Effect of comprehensive care coordination on Medicaid expenditures compared with usual care among children and youth with chronic disease. JAMA Netw Open. 2(10); e1912604. (2019);
CHECK is a Centers for Medicare & Medicaid Services Innovation (CMMI; MD, USA)-funded initiative seeking to lower the healthcare costs – especially regarding emergency department admissions – of pediatric, chronic disease patients. A broad approach to care coordination is taken in CHECK; the social determinants of healthcare delivery, caregiver wellness and mental health capacity are all accounted for in the CHECK model, in addition to the regular management of the patients’ chronic disease.
Coordinated care is an approach to healthcare delivery such that all providers involved in the care delivery of a patient make a concerted effort to coordinate their activities to facilitate more timely, resourceful and cost effective healthcare provision.