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The American Journal of Managed Care September 2018
Food Insecurity, Healthcare Utilization, and High Cost: A Longitudinal Cohort Study
Seth A. Berkowitz, MD, MPH; Hilary K. Seligman, MD, MAS; James B. Meigs, MD, MPH; and Sanjay Basu, MD, PhD
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From the Editorial Board: A. Mark Fendrick, MD
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Early Experiences With the Acute Community Care Program in Eastern Massachusetts
Lisa I. Iezzoni, MD, MSc; Amy J. Wint, MSc; W. Scott Cluett III; Toyin Ajayi, MD, MPhil; Matthew Goudreau, BS; Bonnie B. Blanchfield, CPA, SM, ScD; Joseph Palmisano, MA, MPH; and Yorghos Tripodis, PhD
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Lisa M. Kern, MD, MPH; Joanna K. Seirup, MPH; Mangala Rajan, MBA; Rachel Jawahar, PhD, MPH; and Susan S. Stuard, MBA
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Reyan Ghany, MD; Leonardo Tamariz, MD, MPH; Gordon Chen, MD; Elissa Dawkins, MS; Alina Ghany, MD; Emancia Forbes, RDCS; Thiago Tajiri, MBA; and Ana Palacio, MD, MPH
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Melony E. Sorbero, PhD, MS, MPH; Susan M. Paddock, PhD; Cheryl L. Damberg, PhD; Ann Haas, MS, MPH; Mallika Kommareddi, MPH; Anagha Tolpadi, MS; Megan Mathews, MA; and Marc N. Elliott, PhD

Early Experiences With the Acute Community Care Program in Eastern Massachusetts

Lisa I. Iezzoni, MD, MSc; Amy J. Wint, MSc; W. Scott Cluett III; Toyin Ajayi, MD, MPhil; Matthew Goudreau, BS; Bonnie B. Blanchfield, CPA, SM, ScD; Joseph Palmisano, MA, MPH; and Yorghos Tripodis, PhD
The Acute Community Care Program uses paramedics to provide in-home urgent care after regular business hours, aiming to prevent unnecessary emergency department visits.
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The Massachusetts General Hospital/Partners HealthCare Institutional Review Board approved this study.

ACCP Visits, Post-ACCP Hospital Use, and Deaths

CCA received encounter records from EasCare for each ACCP visit. These claims records are linked to CCA member identification numbers, which also link to member enrollment information, claims for all services provided to members, and death dates. We obtained these claims files from CCA and identified numbers of ACCP visits for individual members, ED use, hospital observation unit stays and admissions post ACCP visits, and deaths. Less than 1% of claims did not distinguish between ED visits and observation stays, lumping them into a combined category. We excluded these claims and retained only claims that clearly differentiated the 2 services. We counted claims to quantify the numbers of different visit types and used service dates to identify events within specified time intervals.

ACCP Visit Activities

EasCare tracks all ACCP visits and patients’ dispositions, recording details about each visit, including arrival time and time on scene; patient’s chief complaint treated by the paramedic, as determined by a senior clinician upon reviewing the record; vital signs; tests performed; medications administered and other interventions; and disposition (eg, treated at home, referred to ED). We obtained this information from EasCare.

Patient-Reported Satisfaction With ACCP Visit

From the outset, CCA and EasCare clinical leaders surveyed ACCP patients to identify patient-reported problems and areas for improvement. Because of the novelty of the program, no existing survey precisely fit their needs. They therefore took questions commonly employed in other patient-reported experience surveys as models and created several new questions specific to ACCP. In addition to a final open-ended question, the survey (available upon request) includes 12 questions on topics such as communication, whether ACCP prevented ED visits, comparing ACCP with ED visits, willingness to use ACCP again, and overall satisfaction with care.

A senior EasCare staff member administered the survey by telephone within 30 days of the ACCP visit. Given the survey’s operational purpose (ie, not research), the numbers of calls made, whether a proxy responded, and refusals to participate were not recorded. After 15 months of conducting the survey, staff recognized that frequent ACCP users were weary of being asked to answer the same survey (ie, some persons were surveyed 2 or 3 times). After January 1, 2016, staff administered the survey only once to patients with ACCP visits. Therefore, before year 2, quarter 2, individual patients could have contributed up to 3 survey responses. EasCare provided us with monthly spreadsheets of survey responses, and we compiled these results. Results here represent all surveys conducted.

Cost Per ACCP Visit

To assess the resources required to design and implement ACCP and the costs to operate the program, we examined financial accounting records and interviewed personnel at both EasCare and CCA. We used visit volume and scale by monthly net operating costs retrospectively gathered from the general ledger accounts and payroll records from both EasCare and CCA. EasCare incurs all operating costs of running ACCP and receives a monthly fee from CCA. Given dates of financial information, the cost analysis looked at calendar years 2015 and 2016.

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