A comparison of care management delivery models on the trajectories of medical costs among patients with chronic diseases: 4-year follow-up results

Abstract

Care management is becoming increasingly offered in the U.S. as a means of helping patients better manage their chronic diseases and possibly avoid worsening or exacerbations of their conditions, which can result in potentially avoidable and costly healthcare services. Since care management can be provided using different intervention methods and by different entities, we sought to compare different models of care management delivery on their long-term medical savings. Specifically, we compare health plan provided care management to provider delivered care management. Evaluation of the effectiveness of care management programs can be challenging because it can take time for patients to make recommended changes and then demonstrate healthcare savings associated with those changes. In this study, we modeled the unknown form of the time-varying program effects using a spline-based technique in the Bayesian framework, where the number and locations of knots were treated unknown and learned via reversible jump Markov chain Monte Carlo. We also addressed additional modeling challenges from features seen in our healthcare cost data such as highly right-skewed outcomes with nonconstant variances and extra zeros. To provide a more robust analysis, we incorporated a follow-up period of up to 4 years that is longer than the most of the published studies on care management. The results of this work demonstrate that cost savings do accrue with specific models of care management. In particular, the embedded model of care management was significantly more effective than the health plan provided care management in controlling medical costs after 2 years of engagement, and the savings increased over time. This information should help policy makers and employer groups achieve a better understanding of the potential value of care management.