Hospitalization

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…

Innovative Home Visit Models Associated With Reductions In Costs, Hospitalizations, And Emergency Department Use

Health Aff (Millwood). 2017 Mar 1;36(3):425-432. [Pubmed Abstract]

Ruiz S, Snyder LP, Rotondo C, Cross-Barnet C, Colligan EM, Giuriceo K

Abstract
While studies of home-based care delivered by teams led by primary care providers have shown cost savings, little is known about outcomes when practice-extender teams-that is, teams led by registered nurses or lay health workers-provide home visits with similar components (for example, care coordination and education). We evaluated findings from five models funded by Health Care Innovation Awards of the Centers for Medicare and Medicaid Services. Each model used a mix of different components to strengthen connections to primary care among fee-for-service Medicare beneficiaries with multiple chronic conditions; these connections included practice-extender home visits. Two models achieved significant reductions in Medicare expenditures, and three models reduced utilization in the form of emergency department visits, hospitalizations, or…

Benchmarks for Reducing Emergency Department Visits and Hospitalizations Through CHWs Integrated Into Primary Care: A Cost-Benefit Analysis

Med Care. 2016 Aug 19. [Pubmed Abstract]

Benchmarks for Reducing Emergency Department Visits and Hospitalizations Through Community Health Workers Integrated Into Primary Care: A Cost-Benefit Analysis
Basu S, Jack HE, Arabadjis SD, Phillips RS

Background
Uncertainty about the financial costs and benefits of community health worker (CHW) programs remains a barrier to their adoption.

Objectives
To determine how much CHWs would need to reduce emergency department (ED) visits and associated hospitalizations among their assigned patients to be cost-neutral from a payer’s perspective.

Research Design
Using a microsimulation of patient health care utilization, costs, and revenues, we estimated what portion of ED visits and hospitalizations for different conditions would need to be prevented by a CHW program to fully pay for the program’s expenses. The model simulated CHW programs enrolling patients with a history of at least 1 ED visit for a chronic condition in the prior…