A Patient Centered Intervention to Improve Health and Reduce Medicaid Costs
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Purpose
Medicaid-insured patients with frequent hospitalizations account for a disproportionate share of visits and costs, and have caught the attention of policy makers, creating an impetus for hospitals and health care providers to better understand and control associated expenditures. Many such patients have specific unmet health and social needs. Based on our extensive pilot work with this population, the New York State Department of Health recently awarded the New York City Health and Hospitals Corporation one of seven statewide contracts to implement a Chronic Illness Demonstration Project, aimed at improving care and reducing healthcare expenditures for high cost Medicaid patients. Within this framework, the investigators propose a group-randomized trial design to test whether specific outcomes related to health, functional status, and quality of life resulting from a patient-centered, intensive care coordination and management intervention correlate with improved linkage to primary care while reducing hospitalizations and emergency department visits. The investigators will then relate these benefits to program costs using standard cost-effectiveness analysis techniques. Given that there are few examples of successful interventions for this population and currently unparalleled Medicaid spending, there is an urgent need to demonstrate that interventions to improve care coordination and optimize patients' use of the health and social care system result in more efficient and less costly care.
| Condition | Intervention |
|---|---|
|
High-risk, High-cost Medicaid Services Users |
Other: Intensive care management and coordination Other: usual care |
| Study Type: | Interventional |
| Study Design: | Allocation: Randomized Endpoint Classification: Efficacy Study Intervention Model: Parallel Assignment Masking: Open Label Primary Purpose: Health Services Research |
| Official Title: | A Patient Centered Intervention to Improve Health and Reduce Medicaid Costs |
- The primary outcome is change in health status as measured by the SF-12. [ Time Frame: 6-36 months ] [ Designated as safety issue: No ]The SF-12 is a shorter yet comparable version of the SF-36 and is an accepted measure for evaluating treatment effectiveness in clinical trials.45-46 The SF-12 has both a mental and physical health component, and provides both a physical component summary (PCS) score and mental component summary (MCS) score. This type of health measure is ideal for this study population, which has high rates of chronic disease including mental health diagnoses.
- changes in ED visits and hospitalizations based on Medicaid claims data provided by the New York State Dept of Health [ Time Frame: 6-36 months ] [ Designated as safety issue: No ]We'll evaluate changes in the numbers of ED visits and hospitalizations for enrollees before and after enrollment, and also compare differences between enrollees and those who were eligible for enrollment but not enrolled
- changes in primary care outpatient care [ Time Frame: 6-36 months ] [ Designated as safety issue: No ]For intervention enrollees, we'll evaluate changes in the numbers who report they have a primary care provider before and after enrollment, as well as the number of outpatient primary care visits before and after enrollment
- self reported health [ Time Frame: 6-36 months ] [ Designated as safety issue: No ]changes in self-reported health using the SF-12 for intervention enrollees comparing the baseline report at time of enrollment to 6-12 month intervals after enrollment
| Estimated Enrollment: | 1000 |
| Study Start Date: | August 2009 |
| Estimated Study Completion Date: | December 2012 |
| Primary Completion Date: | September 2011 (Final data collection date for primary outcome measure) |
| Arms | Assigned Interventions |
|---|---|
|
Experimental: Intervention enrollee
HIgh risk fee for service Medicaid recipients identified as eligible by the New York State Dept of Health and enrolled in the intensive care management and coordination intervention
|
Other: Intensive care management and coordination
Care Management Teams comprised of social workers, community based care managers, and dedicated clinicians work to meet patients' needs in both the health care setting and the community. The CIDP model incorporates motivational interviewing, harm reduction, access to housing through our community partners utilizing a Housing First approach, and provides cellular phones for patients when needed, to better enable regular communication with program staff.
|
|
No Intervention: Eligible, not enrolled
Medicaid fee-for-service patients who are identified as eligible for the intervention but are not enrolled. These patients receive usual services provided by Medicaid.
|
Other: usual care
usual care including services for which patients are eligible via fee for service medicaid
|
Show Detailed Description Eligibility| Ages Eligible for Study: | 18 Years and older |
| Genders Eligible for Study: | Both |
| Accepts Healthy Volunteers: | No |
Inclusion Criteria:
Fee-for-service Medicaid over age 18 identified as high-risk (risk score over 30 based on validated case-finding algorithm) by the New York State Department of Health, residing in pre-specified zip codes in the HHC catchment area
Exclusion Criteria:
Medicaid enrollees who are not fee-for-service Under age 18
Contacts and Locations| United States, New York | |
| New York City Health and Hospitals Corporation Central Office, Office of Medical and Professional Affairs | |
| New York, New York, United States, 10012 | |
| Principal Investigator: | Maria C Raven, MD, MPH, MSc | NYU SOM, HHC, UCSF |
More Information
Publications:
| Responsible Party: | New York City Health and Hospitals Corporation |
| ClinicalTrials.gov Identifier: | NCT01602848 History of Changes |
| Other Study ID Numbers: | 09-08-243-05-G |
| Study First Received: | May 17, 2012 |
| Last Updated: | May 18, 2012 |
| Health Authority: | United States: Institutional Review Board |
Keywords provided by New York City Health and Hospitals Corporation:
|
Medicaid frequent users heavy users |
high risk high cost intervention to improve care and reduce Medicaid expenditures |
ClinicalTrials.gov processed this record on May 19, 2013