An Intervention to Improve Care and Reduce Costs for High-Risk Patients with Frequent Hospital Admissions
A high proportion of Medicaid spending goes to a small percentage of high-risk patients. This pilot study examines a unique patient-centered care management intervention and its ability to reduce costs and improve outcomes.
The study took place at a public New York City hospital, Bellevue Hospital Center (BHC). Study patients were Medicaid fee-for-service eligible, aged 18-64, and currently admitted into any inpatient unit at BHC. The intervention utilized a multidisciplinary team approach providing coordinated and responsive care.
Nineteen patients were enrolled in the pilot study; 10 patients remained active in the study throughout the intervention. All 19 study participants were men; all but one were active substance users at enrollment; and nearly all (17/19) were homeless or marginally housed. Cellular phones with minutes were provided to study participants. In the pilot study, 11 hours per month were spent on care management per patient.
- There were 64 inpatient admissions among the participating patients in the 112 months before the intervention. Compared to the following 12 months, there were 40 admissions, a reduction of 37.5 percent.
- Outpatient clinic visits increased and emergency room visits decreased after study enrollment.
- The yearly Medicaid reimbursement of the study hospital fell an average of $16,383 per patient.
This pilot study demonstrates an intervention that may be effective in reducing hospitalizations and Medicaid costs, especially among high-risk patient groups.