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.

Key Findings:

  • 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.