Impact of point-of-care case management on readmissions and costs

Abstract

Objective: To measure the impact of point-of-care case management by a team of diverse clinical specialists at a large medical group on 30-day readmissions and associated costs.

Study design: An intent-to-treat, historical, baseline cohort comparison design.

Methods: A case management team employed by a managed care organization was integrated into the point of care at 4 medical offices of a medical group to provide services to health plan members who were medically hospitalized. Measures included case management process measures, 30-day readmissions and associated costs, and total savings.

Results: Among eligible members, 93% were enrolled in the case management program. In the baseline cohort, 17.60% of members were readmitted within 30 days, compared with 12.08% in the intervention group. Regression models identified case management intervention, prospective risk score, and Medicaid insurance coverage as significantly associated with readmissions and associated costs. Annual savings in 30-day inpatient utilization costs were $1040.74 per member, which considerably exceeded the costs of the program.

Conclusions: Point-of-care case management can be an effective strategy for reducing readmissions and associated costs. Providing services at the point of care allows for greater convenience for members and increased collaboration with physicians. This strategy of a managed care organization collaborating with medical groups and hospitals has the potential to enhance outcomes in accountable care organizations and to support patientcentered medical homes.