Delivering Better Health, Better Care at Lower Cost...


by Partners In Care on July 24, 2013

Case Study 1 – Commercial Health Plan

We work with a health plan, which has an aligned patient membership of more than 15,000.  The patients are seen by our network physicians and healthcare professionals spanning 150 practices across 13 counties in New Jersey.  The Care Coordination activities are led by our Chief Medical Officer and managed by our clinical operations staff, which consists of 13 nurses including registered nurses and licensed practical nurses.  In the second year of the program, the medical cost trend performance for the target population was about 10% below market.  The Quality Index was at market but was improving and expected to continue improving with many gaps in care closed.  The collaboration between our clinical team and the Case Management/Disease Management department at the health plan has lowered hospital readmissions and measurably improved outcomes.

Case Study 2 – Commercial Health Plan

In 2008, using a similar employee structure and model as in Case Study 1, we partnered with a commercial health plan to undertake a Care Coordination and Disease Management program for a population of 7,900 employees with a member population averaging 16,800, 14,200 and 11,500 for 2008, 2009 and Q1 2010 respectively.  The targeted members were at risk or appeared to be at risk for chronic conditions, specifically, Diabetes, Congestive Heart Failure, Asthma, Hypertension and those identified as complex cases through our risk scoring algorithms. In addition, we took interventional steps to address other needs such as gaps in care, preventive measures, ER abuse and medical home services.

Using claims data and working closely with our network of physicians, we addressed gaps in care and treatment opportunities with a focused population management approach, one patient at a time, targeting high and lower-risk patients as well as those needing preventive care.  We engaged the medical home, the physicians and facilitated Care Coordination and intervention services that improved patient care and health while reducing the cost curve.

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From an ROI perspective, over a 3-year period, for every $1.00 invested in our Care Coordination and Disease Management program, a return of $2.90 in cost reduction was generated.

Case Study 3 – Self-Insured Public Sector Employer

In 2012, using a similar employee structure and model as in Case Study 1, we fully implemented our Care Coordination program for about 1,650 members covered under a self-insured Employee Health Benefits Plan administered by a key commercial health plan. After a 30-day implementation period, which included eligibility checks and basic data collection, care coordination efforts began in full force in the second quarter of 2012.

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From an ROI perspective, in the first 9 months, for every $1.00 invested in our Care Coordination program, a return of $2.20 in cost reduction was generated.  

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