Outpatient Complex Case Management: Health System-Tailored Risk Stratification Taxonomy to Identify High-Cost, High-Need Patients Article

Full Text via DOI: 10.1007/s11606-018-4616-2 PMID: 30076572 Web of Science: 000450752600024

Cited authors

  • Price-Haywood, Eboni G.; Petersen, Hans; Burton, Jeffrey; Harden-Barrios, Jewel; Adubato, Mary; Roberts, Melissa; Markward, Nathan


  • BackgroundU.S. health systems, incentivized by financial penalties, are designing programs such as case management to reduce service utilization among high-cost, high-need populations. The major challenge is identifying patients for whom targeted programs are most effective for achieving desired outcomes.ObjectiveTo evaluate a health system's outpatient complex case management (OPCM) for Medicare beneficiaries for patients overall and for high-risk patients using system-tailored taxonomy, and examine whether OPCM lowers service utilization and healthcare costs.DesignRetrospective case-control study using Medicare data collected between 2012 and 2016 for Ochsner Health System.ParticipantsSuper-utilizers defined as Medicare patients with at least two hospital/ED encounters within 180days of the index date including the index event.InterventionOutpatient complex case management.Main MeasuresPropensity score-adjusted multivariable logistic regression analysis was conducted for primary outcomes (90-day hospital readmission; 90-day ED re-visit). A difference-in-difference analysis was conducted to examine changes in per membership per month (PMPM) costs based on OPCM exposure.Key ResultsAmong 18,882 patients, 1197 (6.3%) were identified as high-risk and 470 (2.5%) were OPCM participants with median enrollment of 49days. High-risk OPCM cases compared to high-risk controls had lower odds of 90-day hospital readmissions (0.81 [0.40-1.61], non-significant) and lower odds of 90-day ED re-visits (0.50 [0.32-0.79]). Non-high-risk OPCM cases compared to non-high-risk controls had lower odds of 90-day hospital readmissions (0.20 [0.11-0.36]) and 90-day ED re-visits (0.66 [0.47-0.94]). Among OPCM cases, high-risk patients compared to non-high-risk patients had greater odds of 90-day hospital readmissions (4.44 [1.87-10.54]); however, there was no difference in 90-day ED re-visits (0.99 [0.58-1.68]). Overall, OPCM cases had lower total cost of care compared to controls (PMPM mean [SD]: -$1037.71 [188.18]).ConclusionsUse of risk stratification taxonomy for super-utilizers can identify patients most likely to benefit from case management. Future studies must further examine which OPCM components drive improvements in select outcome for specific populations.

Publication date

  • 2018

Published in

International Standard Serial Number (ISSN)

  • 0884-8734

Start page

  • 1921

End page

  • 1927


  • 33


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