Impact of complex care management on spending and utilization for high-need, high-cost Medicaid patients

Am J Manag Care. 2020 Feb 1;26(2):e57-e63. doi: 10.37765/ajmc.2020.42402.


Objectives: Complex care management programs have emerged as a promising model to better care for high-need, high-cost patients. Despite their widespread use, relatively little is known about the impact of these programs in Medicaid populations. This study evaluated the impact of a complex care management program on spending and utilization for high-need, high-cost Medicaid patients.

Study design: Randomized quality improvement trial conducted at CareMore Health in Memphis, Tennessee. A total of 253 high-need, high-cost Medicaid patients were randomized in a 1:2 ratio to complex care management or usual care.

Methods: Intention-to-treat analysis compared regression-adjusted rates of spending and utilization between patients randomized to the complex care program (n = 71) and those randomized to usual care (n = 127) over the 12 months following randomization. Primary outcomes included total medical expenditures (TME) and inpatient (IP) days. Secondary outcomes included IP admission, emergency department (ED) visits, care center visits, and specialist visits.

Results: Compared with patients randomized to usual care, patients randomized to complex care management had lower TME (adjusted difference, -$7732 per member per year [PMPY]; 95% CI, -$14,914 to -$550; P = .036), fewer IP bed days (adjusted difference, -3.46 PMPY; 95% CI, -4.03 to -2.89; P <.001), fewer IP admissions (adjusted difference, -0.32 PMPY; 95% CI, -0.54 to -0.11; P = .014), and fewer specialist visits (adjusted difference, -1.35 PMPY; 95% CI, -1.98 to -0.73; P <.001). There was no significant impact on care center or ED visits.

Conclusions: Carefully designed and targeted complex care management programs may be an effective approach to caring for high-need, high-cost Medicaid patients.

Publication types

  • Pragmatic Clinical Trial

MeSH terms

  • Adult
  • Facilities and Services Utilization / statistics & numerical data*
  • Female
  • Health Expenditures / statistics & numerical data*
  • Health Services Needs and Demand*
  • Humans
  • Intention to Treat Analysis
  • Male
  • Managed Care Programs*
  • Medicaid
  • Middle Aged
  • Quality Improvement
  • Tennessee
  • United States