• Neal O'Hara, Olivia C Tran, Shantanu Phatakwala, Anita Cattrell, and Youssef Ajami.
• Evolent Health, 800 N Glebe Rd, Arlington, VA 22207. Email: nohara@evolenthealth.com.
• Am J Manag Care. 2020 Jul 1; 26 (7): 296-302.

ObjectivesThe objectives of this study were to estimate the utilization and spending impact of a standardized complex care management program implemented at 5 Next Generation accountable care organizations (NGACOs) and to identify reproducible program features that influenced program effectiveness.Study DesignIn 2016 and 2017, high-risk Medicare beneficiaries aligned to 5 geographically diverse NGACOs were identified using predictive analytics for enrollment in a standardized complex care management program. We estimated the program's impact on all-cause inpatient admissions, emergency department visits, and total medical expenditures (TME) relative to a matched cohort of nonparticipants. In a subanalysis, we studied the modifying effects of intervention fidelity on program impact.MethodsWe created 1897 propensity score-matched case-control pairs based on preprogram similarities in disease profile, predictive risk score, medical cost, and utilization. Changes in outcomes 6 months post program were measured using difference-in-differences analyses. We used principal components analysis to identify program features associated with reduced inpatient admissions, classified cases according to intervention fidelity, and measured postprogram changes in TME for each subgroup.ResultsProgram participation was associated with a 21% reduction in all-cause inpatient admissions (P = .03) and a 22% reduction in TME (P = .02) 6 months after program completion. Relative spending reductions were 2.1 times greater for high-fidelity interventions compared with overall program participation (P < .001).ConclusionsCentrally staffed complex care management programs can reduce costs and improve outcomes for high-risk Medicare beneficiaries. Integrating predictive risk stratification, evidence-based intervention design, and performance monitoring can ensure consistent outcomes.

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