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- Title
A Novel Intervention for High-Need, High-Cost Medicaid Patients: a Study of ECHO Care.
- Authors
Komaromy, Miriam; Bartlett, Judy; Gonzales-van Horn, Sarah R.; Zurawski, Andrea; Kalishman, Summers G.; Zhu, Yiliang; Davis, Herbert T.; Ceballos, Venice; Sun, Xi; Jurado, Martin; Page, Kimberly; Hamblin, Allison; Arora, Sanjeev
- Abstract
<bold>Background: </bold>A small number of high-need patients account for a disproportionate amount of Medicaid spending, yet typically engage little in outpatient care and have poor outcomes.<bold>Objective: </bold>To address this issue, we developed ECHO (Extension for Community Health Outcomes) Care™, a complex care intervention in which outpatient intensivist teams (OITs) provided care to high-need high-cost (HNHC) Medicaid patients. Teams were supported using the ECHO model™, a continuing medical education approach that connects specialists with primary care providers for case-based mentoring to treat complex diseases.<bold>Design: </bold>Using an interrupted time series analysis of Medicaid claims data, we measured healthcare utilization and expenditures before and after ECHO Care.<bold>Participants: </bold>ECHO Care served 770 patients in New Mexico between September 2013 and June 2016. Nearly all had a chronic mental illness, and over three-quarters had a chronic substance use disorder.<bold>Intervention: </bold>ECHO Care patients received care from an OIT, which typically included a nurse practitioner or physician assistant, a registered nurse, a licensed mental health provider, and at least one community health worker. Teams focused on addressing patients' physical, behavioral, and social issues.<bold>Main Measures: </bold>We assessed the effect of ECHO Care on Medicaid costs and utilization (inpatient admissions, emergency department (ED) visits, other outpatient visits, and dispensed prescriptions.<bold>Key Results: </bold>ECHO Care was associated with significant changes in patients' use of the healthcare system. At 12 months post-enrollment, the odds of a patient having an inpatient admission and an ED visit were each reduced by approximately 50%, while outpatient visits and prescriptions increased by 23% and 8%, respectively. We found no significant change in overall Medicaid costs associated with ECHO Care.<bold>Conclusions: </bold>ECHO Care shifts healthcare utilization from inpatient to outpatient settings, which suggests decreased patient suffering and greater access to care, including more effective prevention and early intervention for chronic conditions.
- Subjects
NEW Mexico; UNITED States; MEDICAID costs; NURSE practitioners; TIME series analysis; COMMUNITY mental health services; MEDICAL care costs; MEDICAID; ECHO; RESEARCH; HOSPITAL emergency services; RESEARCH methodology; MEDICAL cooperation; EVALUATION research; PATIENTS' attitudes; COMPARATIVE studies; HOSPITAL care
- Publication
JGIM: Journal of General Internal Medicine, 2020, Vol 35, Issue 1, p21
- ISSN
0884-8734
- Publication type
journal article
- DOI
10.1007/s11606-019-05206-0