Abstract
Mobile Integrated Healthcare (MIH) is a patient-centered, innovative delivery model offering on-demand, needs-based care and preventive services, delivered in the patient's home or mobile environment. An interprofessional MIH clinical team delivered a care coordination program for a Medicare Advantage Preferred Provider Organization that was risk assigned prior to intervention to target the highest risk members. Using claims and eligibility data, 6 months of pre-program experience and 6 months of program-influenced experience from the intervention cohort was compared to a propensity score–matched comparison cohort to measure impact. The intervention led to a reduction in inpatient and emergency department utilization, resulting in net savings amount totals of $2.4 million over the 6 months of the program. After accounting for the costs of implementing the program, the intervention produced a return on investment of 2.97. Additionally, high patient activation and experience lend strength to this MIH intervention as a promising model to reduce utilization and costs while keeping patient satisfaction high.
Highlights
The US health care system has been increasingly impacted by high costs and variable quality, prompting reform through value-focused reimbursement models.[1]
Given that the control cohort was propensity score matched to the intervention cohort for the purposes of this study (HCC risk scores, demographics, and potentially avoidable costs), the study team finds there to be no significant difference between the 2 cohorts in terms of sex, age, risk score, or comorbidities, and the groups are appropriate for comparison
These utilization differences correlated to the observed differences in per-member per-month (PMPM) costs between the intervention cohort and matched control, and represent estimated savings per patient
Summary
The US health care system has been increasingly impacted by high costs and variable quality, prompting reform through value-focused reimbursement models.[1] Even with this shift toward value, health care expenditures continue to be higher in the United States than in other developed countries, while quality and health outcomes lag behind. One strategy for decreasing total health care costs is to reduce wasteful spending. The Institute of Medicine estimated that in 2009 the United States wasted $750 billion on unnecessary health spending, or roughly 30% of total health care costs for the country that year.[2] There are many types of medical waste – overpriced drugs and procedures, medically unnecessary services, excessive administrative costs3 – and these complex issues are challenging to address. By understanding impactable areas of waste, health care stakeholders may begin to address this problem. An historic lack of post-acute transitional care services and the inability of patients to receive timely followup with their primary care physician outside of traditional business hours has led to a significant gap in the quality and access to care for this population
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