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Background <p>A prior randomized trial assessed three care management (CM) interventions that were designed for adults at high risk of negative health outcomes following a hospital admission and implemented by a large health plan. These CM interventions positively and equivalently impacted several patient-centered outcomes over time.</p> Objective <p>Use the prior randomized trial as the basis for testing post-hospitalization utilization and cost impacts (1) across three CM models (primary analysis) and (2) for each CM model (secondary analysis).</p> Design <p>Post hoc comparison of three randomly assigned integrated CM interventions (IC) and a randomly selected, contemporaneous usual care control group (UC).</p> Participants <p>Recently discharged high-risk Medicaid or dual-eligible Medicaid/Medicare members with multiple chronic conditions.</p> Interventions <p>Three CM interventions: high-tech (4–12&#xa0;months of remote patient monitoring with video visits/condition-specific texts and telephonic visits; <i>n</i> = 365); high-touch (4–12&#xa0;months of telephonic visits; <i>n</i> = 335); optimal discharge planning (ODP; 2–4&#xa0;weeks of telephonic visits; <i>n</i> = 149). All three included an initial in-person visit.</p> Main Measures <p>Ninety-day readmission and emergency department (ED) visit rates; 12-month member care costs (total, medical, pharmacy).</p> Key Results <p>UC had access to, but rarely used, traditional health plan CM. Compared to UC members (<i>N</i> = 886), IC members (<i>N</i> = 886) had similar total cost of care (<i>p</i> = 0.58). IC pharmacy costs trended 93.6% higher (<i>p</i> = 0.06) while medical costs trended 52.5% lower (<i>p </i>= 0.10), despite higher 90-day ED visit rates (IC 32.4% vs. UC 25.5% UC, <i>p</i> = 0.001) and no impact on 90-day readmission rate (IC 16.5% vs. UC 16.3%, <i>p </i>= 0.90). None of the three CM interventions showed an overall comparative advantage, despite some variations in their post-discharge utilization and cost impacts.</p> Conclusions <p>The three post-discharge CM interventions tested showed promise as cost-neutral interventions within a large health plan setting. CM engagement may reduce medical cost specifically despite its impact on readmissions and ED use, though further evaluations of CM interventions are needed.</p>

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Effect of Integrated Care Management Interventions on Post-hospitalization Utilization and Cost Outcomes for Adults with Multiple Chronic Conditions

  • 期刊论文

  • 发表日期：

    2026年4月27日

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  • Mary Winger Knueven,
  • Yushu Liu,
  • Jane Kogan ,
  • Dan Swayze,
  • Heidi Stevenson,
  • Sarah Markwardt,
  • James Schuster,
  • Kelly Williams

摘要

Background

A prior randomized trial assessed three care management (CM) interventions that were designed for adults at high risk of negative health outcomes following a hospital admission and implemented by a large health plan. These CM interventions positively and equivalently impacted several patient-centered outcomes over time.

Objective

Use the prior randomized trial as the basis for testing post-hospitalization utilization and cost impacts (1) across three CM models (primary analysis) and (2) for each CM model (secondary analysis).

Design

Post hoc comparison of three randomly assigned integrated CM interventions (IC) and a randomly selected, contemporaneous usual care control group (UC).

Participants

Recently discharged high-risk Medicaid or dual-eligible Medicaid/Medicare members with multiple chronic conditions.

Interventions

Three CM interventions: high-tech (4–12 months of remote patient monitoring with video visits/condition-specific texts and telephonic visits; n = 365); high-touch (4–12 months of telephonic visits; n = 335); optimal discharge planning (ODP; 2–4 weeks of telephonic visits; n = 149). All three included an initial in-person visit.

Main Measures

Ninety-day readmission and emergency department (ED) visit rates; 12-month member care costs (total, medical, pharmacy).

Key Results

UC had access to, but rarely used, traditional health plan CM. Compared to UC members (N = 886), IC members (N = 886) had similar total cost of care (p = 0.58). IC pharmacy costs trended 93.6% higher (p = 0.06) while medical costs trended 52.5% lower (p = 0.10), despite higher 90-day ED visit rates (IC 32.4% vs. UC 25.5% UC, p = 0.001) and no impact on 90-day readmission rate (IC 16.5% vs. UC 16.3%, p = 0.90). None of the three CM interventions showed an overall comparative advantage, despite some variations in their post-discharge utilization and cost impacts.

Conclusions

The three post-discharge CM interventions tested showed promise as cost-neutral interventions within a large health plan setting. CM engagement may reduce medical cost specifically despite its impact on readmissions and ED use, though further evaluations of CM interventions are needed.