Public Payers News

Chronic Disease Coordinated Care May Not Impact Pediatric Spending

Chronic disease coordinated care may help decrease emergency department visits and inpatient utilization but not pediatric spending.

By Kelsey Waddill

- Inpatient healthcare costs and emergency department visits went down for chronically ill children when they received coordinated care but these results were potentially also achievable through usual care, according to a study by the University of Illinois Health and Health Sciences System.

A quarter of American children have at least one chronic disease. Most of those children come from low-income and minority families. Inpatient care for chronically ill children absorbs a high amount of Medicaid spending, leading researchers to explore methods of cutting costs.

Furthermore, the children may not be receiving quality care, as recent studies indicate that public payers including Medicaid may have worse coordinated care for chronic disease management than private payers.

Coordinated care and medical home models proved effective at reducing healthcare spending for childhood chronic disease management. However, these strategies have been difficult to replicate in a hospital setting on a large scale.

The University of Illinois study found that a coordinated care program did effectively lower inpatient healthcare costs for chronically ill children and young adults, more specifically for their emergency department (ED) care. However, the decreases were nearly matched by the decreases in the control group which did not receive coordinated care intervention.

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“We set out to demonstrate the feasibility of a large-scale care coordination model for a pediatric population, and by blending use of community health workers and social work professionals with health information technology, we’ve accomplished that,” Benjamin Van Voorhees, MD, CHECK project director and senior author of the study, said in the press release.

The researchers implemented the University’s Coordinated Healthcare for Complex Kids (CHECK) program in an inpatient and ED setting to see if and how it would affect Medicaid spending.

CHECK provides mental healthcare and chronic disease management specifically for children and young adults under the age of 25 on Medicaid over a three-year timeframe. CHECK services coordinated community health workers and mental health experts to do an in-person needs assessment, recommend care options, and follow up with a monthly phone call.

Expenditures decreased for the CHECK group and the group that received usual care without an intervention.

Both saw a decrease in overall healthcare spending. Prior to the intervention, the CHECK group spent a mean of around $1,630 on overall annual healthcare and the usual care group spent a mean of around $1,700. This dropped about $300 for both groups, the CHECK group to a mean of $1,341 and the usual care group to a mean of $1,413.

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Likewise, each group lowered their mean of inpatient healthcare spending by $125 for the CHECK group and $111 for the usual care group. In the ED expenditures, each dropped a little over $20 between before and after the intervention.

To gauge CHECK’s effectiveness, the study looked not only at dollar amounts but also at utilization. The rate of inpatient hospitalization decreased by 30.9 percent and ED admissions by around 18 percent, as did the usual care group’s rates. The study received similarly positive results across all disease types.

The decrease in CHECK expenditures and utilization is key because in previous studies the results showed an increase in both utilization and spending, the researchers noted. They also mentioned that the health workers emphasized lowering ED utilization because of its high prevalence among CHECK participants, particularly medium to high risk patients and those with asthma or sickle cell disease. Thus, the drop in ED utilization signifies that coordinated care could be an effective tool against unnecessary or preventable ED admissions and readmissions.

Nonetheless, the results clearly were not aligned with the researchers’ anticipations. The study notes that the length of the program and the state’s shift from fee-for-service into a managed care model may have dampened CHECK’s impact on Medicaid spending.

“We have a lot to learn from this model, and while this data is not what we expected, it will help us refine the program,” Van Voorhees said. “CHECK aims to address very complex challenges in our health care system by removing the barriers many families experience when it comes to accessing or benefitting fully from care. Cost is an important part of the CHECK story, but it is not its complete story. This study gets us a step closer to understanding where and how care coordination is most effective.”

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Coordinated care is already being used to help dual eligibles navigate the healthcare system more easily and to bring cancer patients stress-free treatments and palliative care.

The researchers indicate that, despite the study’s setbacks, coordinated care may still prove useful for lowering costs and increasing quality in pediatric chronic disease management as well.