Cost

A Novel Intervention for High-Need, High-Cost Medicaid Patients: a Study of ECHO Care

J Gen Intern Med. 2020 Jan;35(1):21-27. doi: 10.1007/s11606-019-05206-0. Epub 2019 Oct 30. [Pubmed Abstract]

Komaromy M, Bartlett J, Gonzales-van Horn SR, Zurawski A, Kalishman SG, Zhu Y, Davis HT, Ceballos V, Sun X, Jurado M, Page K, Hamblin A, Arora S

Background
A small number of high-need patients account for a disproportionate amount of Medicaid spending, yet typically engage little in outpatient care and have poor outcomes.

Objective
To address this issue, we developed ECHO (Extension for Community Health Outcomes) Care™, a complex care intervention in which outpatient intensivist teams (OITs) provided care to high-need high-cost (HNHC) Medicaid patients. Teams were supported using the ECHO model™, a continuing medical education approach that connects specialists with primary care providers for case-based mentoring to treat complex diseases.

Design
Using an interrupted time series analysis of Medicaid claims data, we measured healthcare utilization and…

Cost-effectiveness of a statewide public health intervention to reduce cardiovascular disease risk

BMC Public Health. 2019 Sep 6;19(1):1234. [Pubmed Abstract]

Smith L, Atherly A, Campbell J, Flattery N, Coronel S, Krantz M

Bacgkround
The cost-effectiveness of community health worker (CHW)-based cardiovascular disease (CVD) risk-reduction interventions is not well established. Colorado Heart Healthy Solutions is a CHW-based intervention designed to reduce modifiable CVD risk factors. This program has previously demonstrated success, but the cost-effectiveness is unknown. CHW-based interventions are potentially attractive complements to healthcare delivery because laypersons implement the intervention at a lower cost relative to medical care and may be attractive in rural settings with limited clinical resources.

Method
CHWs performed screenings and provided ongoing participant support within predominantly rural communities. A point-of-service software tool was used to generate 10-year Framingham CVD risk scores and assist CHWs to make medical referrals and provide ongoing…

Impact Of Health Care Delivery System Innovations On Total Cost Of Care

Health Aff (Millwood). 2017 Mar 1;36(3):509-515. [Pubmed Abstract]

Smith KW, Bir A, Freeman NL, Koethe BC, Cohen J, Day TJ

Abstract
Using delivery system innovations to advance health care reform continues to be of widespread interest. However, it is difficult to generalize about the success of specific types of innovations, since they have been examined in only a few studies. To gain a broader perspective, we analyzed the results of forty-three ambulatory care programs funded by the first round of the Center for Medicare and Medicaid Innovation’s Health Care Innovations Awards. The innovations’ impacts on total cost of care were estimated by independent evaluators using multivariable difference-in-differences models. Through the first two years, most of the innovations did not show a significant effect on total cost of care. Using meta-regression, we assessed the effects on costs of five common components of these innovations. Innovations that used health information…