A Randomized Controlled Trial of Intensive Care Management for Disabled Medicaid Beneficiaries with High Health Care Costs

Abstract

Objective. To evaluate outcomes of a registered nurse-led care management intervention for disabled Medicaid beneficiaries with high health care costs. Data Sources/Study Setting. Washington State Department of Social and Health Services Client Outcomes Database, 2008Database, -2011 Study Design. In a randomized controlled trial with intent-to-treat analysis, outcomes were compared for the intervention (n = 557) and control groups (n = 563). A quasiexperimental subanalysis compared outcomes for program participants (n = 251) and propensity score-matched controls (n = 251). Data Collection/Extraction Methods. Administrative data were linked to describe costs and use of health services, criminal activity, homelessness, and death. Principal Findings. In the intent-to-treat analysis, the intervention group had higher odds of outpatient mental health service use and higher prescription drug costs than controls in the postperiod. In the subanalysis, participants had fewer unplanned hospital admissions and lower associated costs; higher prescription drug costs; higher odds of long-term care service use; higher drug/alcohol treatment costs; and lower odds of homelessness. Conclusions. We found no health care cost savings for disabled Medicaid beneficiaries randomized to intensive care management. Among participants, care management may have the potential to increase access to needed care, slow growth in the number and therefore cost of unplanned hospitalizations, and prevent homelessness. These findings apply to start-up care management programs targeted at high-cost, high-risk Medicaid populations.

Effectiveness of interventions to reduce homelessness: a systematic review and meta‐analysis

“…In one study (44), high intensity case management seemed to lead to fewer months homeless (mean number of months per 100 months homeless). However, the 95% confidence interval indicates that high intensity case management might make little or no difference the amount of time spent homeless (results as reported in original publication: n=-1.5 [95% CI -4.3 to 1.3], p=0.29).…”

“…Thirteen of the included studies examined homelessness (39, 44-46, 48, 50, 54, 59, 60, 70, 71, 80, 83). Seven studies reported outcomes related to length of time homeless, either in terms of number of months (44) or number of days (39,46,50,60,71,80).…”

“…One study reported that participants in the high intensity case management group reported spending almost half as many days living on the street than participants in the usual services group (MD=0-14.10 (-15.77, -12.43)) (60) Three studies reported whether participants experienced homelessness during the study period (44,48,83). We conducted a meta-analysis for the number of participants who experienced at least one episode of homelessness within one to two years, pooling data from two studies (48,83).…”

“…We conducted a meta-analysis for the number of participants who experienced at least one episode of homelessness within one to two years, pooling data from two studies (48,83). The third study was not included in the analysis due to incomplete reporting of results (baseline and follow-up percentage of participants was not reported, only the pre-post difference in percentage of participants who experienced homelessness during a two year period was reported along with the difference in difference (44).…”

Long‐Term Impact of a Postdischarge Community Health Worker Intervention on Health Care Costs in a Safety‐Net System

“…Other studies of intensive care management of socially and medically high‐risk patients have shown a lack of cost savings with improved access and increased utilization in the short term (Bell et al. ). However, over several years, there may be a cost savings from care management programs for patients with behavioral health issues (Unutzer et al.…”