High-risk population health management - Achieving improved patient outcomes and near-term financial results

Objective: A managed care organization sought to achieve efficiencies in ca re delivery and cost savings by anticipating and better caring for its frai l and least stable members. Study Design: Time sequence case study of program intervention across an en tire managed care population in its first year compared with the prior base line year. Patients and Methods: Key attributes of the intervention included predictiv e registries of at-risk members based on existing data, relentless focus on the high-risk group, an integrated clinical and psychosocial approach to a ssessments and care planning, a reengineered care management process, secur ed Internet applications enabling rapid implementation and broad connectivi ty, and population-based outcomes metrics derived from widely used measures of resource utilization and functional status. Results: Concentrating on the highest-risk group, which averaged just 1.1% prevalence in the total membership, yielded bottom line results. When the y ear before program implementation (July 1997 through June 1998) was compare d with the subsequent year, the total population's annualized commercial ad mission rate was reduced 5.3%, and seniors' was reduced 3.0%. A claims-paid analysis exclusively of the highest-risk group revealed that their efficie ncies and savings overwhelmingly contributed to the membershipwide effect. This subgroup's costs dropped 35.7% from preprogram levels of $2590 per mem ber per month (excluding pharmaceuticals). During the same time, patient-de rived cross-sectional functional status rose 12.5%. Conclusions: A sharply focused, Internet-deployed case management strategy achieved economic and functional status results on a population basis and p roduced systemwide savings in its first year of implementation.