Evaluation of chronic disease management on outcomes and cost of care for Medicaid beneficiaries

Zhang, Ning Jackie; Wan, Thomas T. H.; Rossiter, Louis F.; Murawski, Matthew M.; Patel, Uresh

doi:10.1016/j.healthpol.2007.11.011

Cited by 21 publications

(17 citation statements)

References 15 publications

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“…Courtney et al [67] observed that comprehensive care favored usual care in terms of mental as well as in terms of physical functioning. Also Zhang et al [75] observed for the majority of aspects of quality of life a significant effect of comprehensive care (i.e. significantly slower deterioration than in the usual care group).…”

Section: Functional Statusmentioning

confidence: 94%

“…Seven programs focused on multimorbid older people who were (acutely) hospitalized and who sometimes had a history of readmissions or were at risk for readmissions [65][66][67][68][69][70][71][72][73][74]. Five programs focused on older people with (a combination of) specific chronic conditions such as diabetes mellitus, heart failure, COPD, dementia and/or arthritis [40,42,[75][76][77][78][79], and one program focused on people aged 50 years or older who were at risk of functional decline or physical deterioration [41] (Table 1). …”

Section: Target Populationsmentioning

confidence: 99%

“…Except for one program [75], all comprehensive care programs included interventions related to the CCM component delivery system design. Examples are employing a case manager, working in multidisciplinary teams, designing individualized care plans, and making home visits to patients.…”

Section: Contentsmentioning

confidence: 99%

“…number of ER visits, hospital readmission rate, length of hospital stay, number of hospitalizations, and percentage of patients using nursing home care). Comprehensive care favored usual care in six studies [51,56,67,72,74,75]. In two of these studies the ER visit rate was significantly lower in the comprehensive care group than in the usual care group [51,75].…”

Section: Mortality Mortality Was Evaluated In Six Studiesmentioning

confidence: 99%

See 3 more Smart Citations

Comprehensive care programs for patients with multiple chronic conditions: A systematic literature review

et al. 2012

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Section: Functional Statusmentioning

confidence: 94%

Section: Target Populationsmentioning

confidence: 99%

Section: Contentsmentioning

confidence: 99%

Section: Mortality Mortality Was Evaluated In Six Studiesmentioning

confidence: 99%

See 2 more Smart Citations

Comprehensive care programs for patients with multiple chronic conditions: A systematic literature review

et al. 2012

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“…25 A study of more than 35,000 clients enrolled in a Virginia Medicaid PHM/DM program found statistically significant improvements ''in patient's drug compliance and quality of life while reducing (ER), hospital, and physician office visits and adverse events,'' with a specific cost savings related to reduced hospitalization rates. 26 27 but other costs, such as pharmaceutical expenditures, increased and no cost offsets were found. 6 Even so, studies of this program have found additional benefits in clinical measures such as blood pressure, cholesterol control, and medication adherence.…”

Section: Discussionmentioning

confidence: 96%

Economic Impact of a Medicaid Population Health Management Program

Rust

Strothers

Miller

et al. 2011

Population Health Management

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A population health management program was implemented to assess growth in health care expenditures for the disabled segment of Georgia's Medicaid population before and during the first year of a population health outcomes management program, and to compare those expenditures with projected costs based on various cost inflation trend assumptions. A retrospective, nonexperimental approach was used to analyze claims data from Georgia Medicaid claims files for all program-eligible persons for each relevant time period (intent-to-treat basis). These included all non-Medicare, noninstitutionalized Medicaid aged-blind-disabled adults older than 18 years of age. Comparisons of health care expenditures and utilization were made between base year (2003)(2004) and performance year one (2006)(2007), and of the difference between actual expenditures incurred in the performance year vs. projected expenditures based on various cost inflation assumptions. Demographic characteristics and clinical complexity of the population (as measured by the Chronic Illness and Disability Payment System risk score) actually increased from baseline to implementation. Actual expenditures were less than projected expenditures using any relevant medical inflation assumption. Actual expenditures were less than projected expenditures by $9.82 million when using a conservative US general medical inflation rate, by $43.6 million using national Medicaid cost trends, and by $106 million using Georgia Medicaid's own cost projections for the non-dually eligible disabled segment of Medicaid enrollees. Quadratic growth curve modeling also demonstrated a lower rate of increase in total expenditures. The rate of increase in expenditures was lower over the first year of program implementation compared with baseline. Weighted utilization rates were also lower in high-cost categories, such as inpatient days, despite increases in the risk profile of the population. Varying levels of cost avoidance could be inferred from differences between actual and projected expenditures using each of the health-related inflation assumptions. (Population Health Management 2011;14:215-222)

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Interventions for improving outcomes in patients with multimorbidity in primary care and community settings

Smith

Soubhi

Fortin

et al. 2012

Cochrane Database of Systematic Reviews

337

469

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This review highlights the paucity of research into interventions to improve outcomes for multimorbidity with the focus to date being on co-morbid conditions or multimorbidity in older patients. The limited results suggest that interventions to date have had mixed effects but have shown a tendency to improve prescribing and medication adherence, particularly if interventions can be targeted at risk factors or specific functional difficulties in people with co-morbid conditions or multimorbidity. There is a need for clear definitions of participants, consideration of appropriate outcomes, and further pragmatic studies based in primary care settings.

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Evaluation of chronic disease management on outcomes and cost of care for Medicaid beneficiaries

Cited by 21 publications

References 15 publications

Comprehensive care programs for patients with multiple chronic conditions: A systematic literature review

Comprehensive care programs for patients with multiple chronic conditions: A systematic literature review

Economic Impact of a Medicaid Population Health Management Program

Interventions for improving outcomes in patients with multimorbidity in primary care and community settings

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