Care Coordination Model With Bundled Interventions Dramatically Improved Care in East Baltimore

Effective care coordination can improve health outcomes for patients with chronic conditions, and a new study found that partnering such a model with bundled interventions can lower spending, as well as improve outcomes, for patients in an urban environment. The results were published in JAMA Network Open.

The study analyzed the outcomes and spending of the Johns Hopkins Community Health Partnership, which utilizes a bundle of interventions deployed at 2 acute care hospitals and a care management model embedded in ambulatory primary care sites. From July 2012 to June 2015, there was an acute care intervention (ACI), which focused on improving care coordination, and from June 2015 to June 2016 there was a community intervention (CI), which integrated behavioral health care into a care coordination model.

“The nearly 200 000 residents of East Baltimore, where life expectancy can be 20 years shorter than in more affluent communities nearby, face multiple challenges to their health and well-being,” the authors explained.

An estimated 80,000 participants received services through either the ACI or the CI. The researchers used difference-in-differences study designs to compare outcomes with claims from a preintervention period. Both Medicare and Medicaid participants were included in the study.

For the ACI, there were significant reductions in aggregate costs of care for both Medicare (—$29.2 million) and Medicaid (–$59.8 million). There were increases in 90-day hospitalization and 30-day readmission in Medicare (11 and 14 by per 1000 beneficiary-episodes, respectively). While the 90-day emergency department (ED) visit rate was reduced in Medicaid by 133 per 1000 beneficiary-episodes, the hospitalization rate increased by 49 per 1000 beneficiary-episodes.

For the CI, there were no statistically significant findings for Medicare, but in Medicaid there was a total cost-of-care reduction of $24.4 million with hospitalizations reduced by 33 per 1000 beneficiaries, ED visits by 51 per 1000 beneficiaries, and 30-day readmissions by 36 per 1000 beneficiaries.

Overall, both programs saved $113.3 million by improving the coordination of services.

While the analysis of the Johns Hopkins Community Health Partnership found that a care coordination model was associated with dramatic improvements, “it is worth noting that the size of the effect is likely not wholly generalizable, as other efforts to implement such care delivery transformations will reflect investments made by the organizations, baseline health and utilization of patients served, and the communities in which they reside,” the authors concluded.

Reference

Berkowitz SA, Parashuram S, Rowan K, et al. Association of a care coordination model with health care costs and utilization: the Johns Hopkins Community Health Partnership (J-CHiP). JAMA Netw Open. 2018;1(7):e184273. doi:10.1001/jamanetworkopen.2018.4273.