Title

Health Care Innovation Award (HCIA) Complex/High-risk patient targeting: Third annual report. NORC at the University of Chicago

Document Type

Report

Publication Date

2017

Abstract

This is the third annual report of the evaluation of the Health Care Innovation Award (HCIA) Complex/High-Risk Patient Targeting (CHRPT) portfolio by NORC at the University of Chicago, under contract with the Center for Medicare & Medicaid Innovation (CMMI). We present findings for 23 awardees that serve patients with multiple chronic conditions (MCC) who are at high risk for hospitalization, re-hospitalization, emergency department (ED) visits, or nursing home stays. HCIA funding supports pilot testing, replication of established models, and the scaling of innovations to improve the quality of care and health while lowering overall health care cost. (See Exhibit ES.1 for a list of awardees and HCIA-supported innovations, with corresponding funding amounts.) Four of the awardees are implementing innovations that have two or more distinct programs or arms, each of which is assessed separately. These awardees include J-CHiP (post-acute care or hospital-based arm and ambulatory care community arm), PPMC (NORC’s evaluation considers the six arms for which adequate claims data are available), St. Francis (post-acute care or hospital-based arm and ambulatory care community arm), and U North Texas (implementation in skilled nursing facilities, assisted living/memory care residences, and independent living residences).

Key outcomes of interest (e.g., core measures) include total cost of care, utilization (all-cause hospital admissions, emergency department visits, hospital readmissions), quality of care (e.g., ambulatory caresensitive hospitalizations, practitioner follow-up visits post-hospital discharge, potentially avoidable hospitalizations), and patient health and well-being. The evaluation utilizes a mixed-methods approach, using a case-study design where each award comprises a case; Exhibit ES.2 depicts our evaluation conceptual framework. Data sources include Medicare and Medicaid claims, workforce trainee surveys and surveys of beneficiary and caregiver experience, program documents and awardee reports to CMMI, and primary data collected through awardee interviews and site visits.

We present program effectiveness findings for the 23 CHRPT awardees, based on claims, survey, and qualitative data, highlighting the nine awardees that have achieved cost savings or improved utilization and/or quality of care without significantly increasing the total cost of care. All claims-based findings presented are from difference-in-differences models, comparing the experiences of enrolled beneficiaries with those of a matched comparison group. Our study design reports claims-based outcomes in terms of beneficiary-episodes for innovations that address post-acute care (hospital evaluation design) and beneficiaries for innovations that address ambulatory care (community evaluation design). While findings are described in terms of impact on measures, our assessment judgments are about association rather than causation. In addition to findings about program effectiveness, we include an analysis of themes across pairs and groups of awardee interventions, identifying emerging best practices for serving medically complex populations, for workforce development, and for sustaining, replicating, and scaling innovation.

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