The business case for adult disability care coordination

Abstract

Design: The study used a retrospective pretest, posttest design of 245 beneficiaries. Physical impairment ranged from slight to severe.

Setting: Minnesota Disability Health Options (MnDHO), a capitated Medicaid program.

Participants: Medicaid beneficiaries ages 18 to 64 with physical disabilities arising from multiple sclerosis, cerebral palsy, spinal cord injury, or brain injury.

Interventions: Not applicable.

Main outcomes measures: Change in expenditures, rate of return, and utilization.

Results: Mean MnDHO monthly expenditures including care coordination increased by a factor of 1.75 (P<.001) over the previous expenditures. Increasing age has a multiplier effect on increased expenditures. Hospitalization rates were unchanged, but the average cost per admission and average length of stay dropped significantly (P=.017, P=.032, respectively). For people enrolled at least 3 years, annual reductions in medical costs more than paid for the added cost of care coordination, but the savings in Year 3 were about 20% of the savings in the first 2 years.

Conclusions: Care coordination leads to higher program expenditures for enrollees with moderate physical impairments who encounter access problems, but has little impact on enrollees who are already getting 24-hour care. There is some evidence of adverse selection bias. MnDHO's disability care coordination may not be financially sustainable over the long term.