• Benjamin Ukert, Guy David, and Aaron Smith-McLallen.
• Texas A&M University, 212 Adriance Lab Rd, College Station, TX 77843. Email: bukert@tamu.edu.
• Am J Manag Care. 2022 Dec 1; 28 (12): 668674668-674.

ObjectivesTo evaluate the effect of a predictive algorithm-driven disease management (DM) outreach program compared with non-predictive algorithm-driven DM program participation on health care spending and utilization.Study DesignWe used propensity score matching forMedicare Advantage members with chronic heart failure (CHF) to evaluate the impact of predictive algorithm-driven DM outreach using claims data from 2013 to 2018 from a large commercial health insurer.MethodsThe insurer ran a predictive algorithm to identify members with CHF with a high likelihood of hospitalization (LOH), and a DM outreach was initiated to those identified as being at high risk of hospitalization (high-LOH intervention group). The intervention group was matched to members with similar concurrent medical risk profiles, based on the DxCG/Verisk score, who received the same DM outreach through the insurer's standard process (low-LOH intervention group). This approach allowed an evaluation of the predictive algorithm in targeting individuals suitable for DM outreach.ResultsRegression models showed that high-LOH intervention members had a lower probability of hospitalization (0.032; P = .075) and emergency department (ED) visit (0.039; P = .043) in the year after the outreach compared with low-LOH intervention members, leading to lower total outpatient spending ($1517; P < .001). Analyses for no-intervention members showed that predictive outreach members would have been expected to have higher inpatient and ED utilization and higher medical spending compared with the traditional care members.ConclusionsA prediction-driven DM outreach program among patients with CHF was effective in reducing medical spending in the year after the outreach compared with traditional DM outreach programs.

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