Christine Vogeli, PhD

In Massachusetts’ largest Medicaid accountable care organization (ACO), high-risk care management significantly reduced spending, emergency department visits, and hospitalizations, demonstrating that targeted strategies can manage health care costs amid budget constraints.

Although commercial accountable care organization populations are healthy on average, some individuals might benefit from programs for high-risk patients to mitigate high levels of health care utilization.

Payment models that align financial incentives of payers, providers, and patients can mitigate spending growth in thoughtful ways, but the details of the models matter.

The authors present findings of a randomized evaluation of Medicaid patients at an academic medical center, which found that intensive care management was associated with reduced total medical expense.

A navigation program demonstrated decreased odds of repeat emergency department (ED) visits in patients with low baseline ED utilization and increased odds of follow-up primary care appointments.

Hybrid approaches allow for clinician input into case finding for care management, but training and monitoring is required to protect against unintentional biases.

Clinicians consider a number of patient predisposing and enabling characteristics not typically available in clinical data systems when selecting high-risk patients for care management.

Two standardized rating scales appeared to be valid and reliable for use at admission and possibly follow-up in a child psychiatry system of care.