Beneficiaries enrolled in CCNC use acute hospital services less than similar Medicaid beneficiaries who aren’t enrolled. This is the result of effective prevention that keeps patients out of the hospital or emergency room, and through coordinated transitional care for patients who do go to the hospital.
Evidence
Health Affairs (2013)
A peer-reviewed study published in Health Affairs examined the effectiveness of CCNC’s statewide transitional care program for Medicaid recipients with complex, chronic conditions. Investigators from CCNC and the University of North Carolina at Chapel Hill examined time to hospital readmission and one-year readmission rates for patients with multiple chronic conditions, comparing those who received transitional care with clinically similar patients who received usual care in the period July 2010-June 2011. A total of 21,375 Medicaid recipients with a hospital discharge in the study period met the inclusion criteria. Of those, 13,476 received a transitional care assessment or intervention by a program care manager. This included patients discharged from 120 different hospitals, enrolled in 1,325 primary care medical homes, and residents of 99 of North Carolina's 100 counties. Risk-adjusted readmission rates were 20 percent lower for Medicaid beneficiaries who received CCNC transitional care support. In addition, the transitional care participants were less likely than others to experience multiple readmissions over the following year. In total, one readmission was averted for every six patients with complex chronic illnesses who received transitional care. The full text of the article is available here.
Performance Analysis of Healthcare Utilization Trends (2012)
Treo Solutions, a health care analytics consultant, analyzed CCNC’s impact on service utilization by NC Medicaid recipients 2007-2010, adjusting for each individuals’ clinical risk. Inpatient and ER utilization were consistently lower for the CCNC-enrolled population while primary care visits and pharmaceutical prescriptions were higher, a pattern consistent with high-performing primary care medical homes.
Favorable utilization patterns for the CCNC-enrolled population were seen at the:
- Overall population level (enrolled vs. unenrolled);
- Within each CCNC population segment (ABD, Adult Non-ABD, and Child Non-ABD); and
- Among specific population health status cohorts as determined by aggregated Clinical Risk Groups (e.g., children with asthma or adults who are categorized as having two or more chronic conditions). Even among the heaviest users of health care services, the CCNC-enrolled population continues to demonstrate a pattern of lower inpatient and ER utilization and higher PCP visit and prescription rates than does the unenrolled Medicaid population.
The full text of the report is available here.