PDF(Pubmed)
Abstract：
BACKGROUND: 5% of patients account for the majority of healthcare spend, but standardized interventions for this complex population struggle to generate return on investment. The aim of this study is the development and proof of concept of an adaptive intervention to reduce cost and risk of readmission for medically high-risk individuals with any behavioral health diagnosis.
METHODS: A behaviorally-oriented, personalized care service was delivered using a consultative, team-based approach including a physician, counselor, dietitian and social worker in collaboration with nurse care coordinators. Iterative re-conceptualizations informed tailored treatment approaches to prevent acute decompensation while retraining behaviors that impeded recovery. This service was offered to a small set of members of the employee health plan at University Hospitals Cleveland with an existing behavioral health disorder from November of 2020 to March of 2023. 26 members receiving the service were identified and matched with 26 controls using a risk algorithm. Members and controls were then classified as high utilizers (n = 14) or standard utilizers (n = 38) based on utilization claims data.
RESULTS: Primary outcomes of this study included medical expenditures (delineated as planned and unplanned spend) and readmission risk scores. Compared to risk-matched controls, both planned and unplanned health care expenditures significantly decreased (p < .05) for 7 high utilizers, and unplanned spend only significantly decreased for 19 standard utilizers (p < .05). Risk scores, which predict future spend, decreased significantly for standard utilizers (p < .05), but not for high utilizers.
CONCLUSIONS: The value of a behaviorally-oriented personalized care intervention for medically high-risk patients in a commercial insurance population was demonstrated through decreased spend for high utilizers and decreased risk for standard utilizers. Further expansion, refinement, evaluation and scaling are warranted.
METHODS: A behaviorally-oriented, personalized care service was delivered using a consultative, team-based approach including a physician, counselor, dietitian and social worker in collaboration with nurse care coordinators. Iterative re-conceptualizations informed tailored treatment approaches to prevent acute decompensation while retraining behaviors that impeded recovery. This service was offered to a small set of members of the employee health plan at University Hospitals Cleveland with an existing behavioral health disorder from November of 2020 to March of 2023. 26 members receiving the service were identified and matched with 26 controls using a risk algorithm. Members and controls were then classified as high utilizers (n = 14) or standard utilizers (n = 38) based on utilization claims data.
RESULTS: Primary outcomes of this study included medical expenditures (delineated as planned and unplanned spend) and readmission risk scores. Compared to risk-matched controls, both planned and unplanned health care expenditures significantly decreased (p < .05) for 7 high utilizers, and unplanned spend only significantly decreased for 19 standard utilizers (p < .05). Risk scores, which predict future spend, decreased significantly for standard utilizers (p < .05), but not for high utilizers.
CONCLUSIONS: The value of a behaviorally-oriented personalized care intervention for medically high-risk patients in a commercial insurance population was demonstrated through decreased spend for high utilizers and decreased risk for standard utilizers. Further expansion, refinement, evaluation and scaling are warranted.
摘要：
背景：5%的患者占医疗支出的大部分，但是对这种复杂人口的标准化干预难以产生投资回报。这项研究的目的是开发和证明适应性干预的概念，以降低具有任何行为健康诊断的医学高风险个体的成本和再入院的风险。
方法：行为导向，个性化护理服务是通过咨询机构提供的，以团队为基础的方法，包括医生，顾问,营养师和社会工作者与护士护理协调员合作。迭代重新概念化告知了量身定制的治疗方法，以防止急性代偿失调，同时再训练阻碍康复的行为。这项服务提供给克利夫兰大学医院的一小部分员工健康计划成员，他们在2020年11月至2023年3月期间存在行为健康障碍。使用风险算法确定了26名接受服务的成员，并将其与26名控件进行匹配。然后，根据利用率索赔数据，将成员和对照分为高利用率（n=14）或标准利用率（n=38）。
结果：本研究的主要结果包括医疗支出（计划和计划外支出）和再入院风险评分。与风险匹配的控制相比，7个高使用率者的计划和计划外医疗保健支出均显著下降(p<0.05)，19个标准使用者的计划外支出仅显著下降(p<0.05)。风险评分,预测未来的支出，标准利用率显著下降(p<0.05)，但不是高利用率。
结论：在商业保险人群中，以行为为导向的个性化护理干预对医疗高风险患者的价值通过降低高使用率的支出和降低标准使用率的风险得到证明。进一步扩大,精致,评估和缩放是有保证的。
方法：行为导向，个性化护理服务是通过咨询机构提供的，以团队为基础的方法，包括医生，顾问,营养师和社会工作者与护士护理协调员合作。迭代重新概念化告知了量身定制的治疗方法，以防止急性代偿失调，同时再训练阻碍康复的行为。这项服务提供给克利夫兰大学医院的一小部分员工健康计划成员，他们在2020年11月至2023年3月期间存在行为健康障碍。使用风险算法确定了26名接受服务的成员，并将其与26名控件进行匹配。然后，根据利用率索赔数据，将成员和对照分为高利用率（n=14）或标准利用率（n=38）。
结果：本研究的主要结果包括医疗支出（计划和计划外支出）和再入院风险评分。与风险匹配的控制相比，7个高使用率者的计划和计划外医疗保健支出均显著下降(p<0.05)，19个标准使用者的计划外支出仅显著下降(p<0.05)。风险评分,预测未来的支出，标准利用率显著下降(p<0.05)，但不是高利用率。
结论：在商业保险人群中，以行为为导向的个性化护理干预对医疗高风险患者的价值通过降低高使用率的支出和降低标准使用率的风险得到证明。进一步扩大,精致,评估和缩放是有保证的。
