A population health management program developed for children enrolled in Medicaid helped reduce hospital admissions and bed-days.
Children enrolled in Medicaid who are exposed to a population health management program could experience 50 fewer hospital admissions each month and 3,600 fewer bed-days in a year, according to a study published in JAMA Network Open.
Researchers noted that nearly 40 percent of children in the US are covered by Medicaid, and Medicaid now provides reimbursement for more than half of neonatal pediatric hospitalizations. Pediatric health systems are experiencing capacity challenges due to large numbers of patients with complex conditions, who account for an increasing proportion of inpatient days.
Because of these trends, many pediatric health systems are seeking population-based initiatives that will help reduce preventable hospital admissions and inpatient stays without sacrificing care quality.
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Researchers implemented a population health management program in a primary care network, providing targeted care team interventions for children with complex medical and social needs. Patients with the greatest service utilization were provided a team of clinicians, nurses, and social workers to actively manage their care across inpatient and ambulatory settings.
Clinicians and staff also used registry and reporting tools within the EHR to respond to patients’ emergency department and hospital utilization, schedule timely care visits and immunizations, and proactively prepare for upcoming specialty care visits. These tools stratified patients by risk and alerted providers about emergency department visits in the area, leading to more proactive outreach and follow-up care.
Researchers found that children exposed to the population health program experienced a reduction of 0.39 monthly admissions and 2.20 monthly bed-days per 1,000 children, compared to pediatric patients not exposed to the program. Annually, these results could translate to a reduction of 3,600 bed-days for a population of 93,000 children eligible for Medicaid.
The research group attributes the success of the program to its integrated care teams and its focus on a specific patient population.
“The targeted approach described in our study provides a scalable and cost-effective strategy for other health systems as they determine the size of their investments and prioritization of programs for population health initiatives,” the team stated.
“Although other health systems may focus interventions on patients with different clinical profiles, the success of this population-level intervention was driven by financial investments in the development of integrated care teams, alignment between clinical and quality improvement methods, and the wide availability of EHR tools.”
The program proved to help organizations significantly reduce care expenses for medically complex patients.
“The magnitude of savings achieved for reducing inpatient bed-days was nearly 6-fold the investment that the health system made in hiring integrated care teams and expanding access to registry and reporting tools. Ambulatory utilization also increased.”
The researchers are confident that their results demonstrate the effectiveness of population health management programs for high-risk, vulnerable patient populations.
“As pediatric health systems seek to integrate population health programs, few robust evaluations of such initiatives exist, particularly among children enrolled in Medicaid,” researchers concluded.
“This study provided quasi-experimental data for how population management, imbued with interdisciplinary teams, quality improvement, and information technology, can help large pediatric health systems respond to the needs of an increasing, medically complex, Medicaid-enrolled population and mitigate capacity challenges by reducing inpatient hospitalization among the managed population.”
Source: Health IT Analytics