JAMA Article (continued ... )

Effects of Care Coordination on Hospitalization, Quality of Care, and Health Care Expenditures Among Medicare Beneficiaries; 15 Randomized Trials

by Deborah Peikes, et. al.

Feb. 11, 2009

The authors also noted that "Health Quality Partners' low fee was nearly fully offset by the treatment group's lower regular Medicare expenditures, and based on the subgroup analyses these savings would have been substantially larger had the program targeted only the highest severity group."  Among the high severity subgroup, representing about 30% of HQP's enrolled participants, the researchers observed
"... -29% for hospitalizations and -20% for expenditures ... P=0.009 and P=.07, respectively ..."

HQP intentionally enrolled low and moderately severe cases at our demonstration site, in addition to high severity cases, to use this unique research opportunity to better understand whether, how, and when persons with different severities and types of chronic illnesses might benefit from care coordination.  This 'public health' perspective - seeking to maximize the population's health per dollar spent, rather than seeking to maximize the ROI on a per enrollee basis, may, in the short run, result in a relative under-valuation of our model by those analyzing our impact using the latter metric.   Nonetheless, we think valuable lessons are still to be learned by continuing to follow this heterogeneous mix of patients, while continuing to reap the significant cost savings realized among high risk individuals.