The American journal of managed care
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To produce an efficient and practically implementable method, based on primary care data exclusively, to identify patients with complex care needs who have problems in several health domains and are experiencing a mismatch of care. The Johns Hopkins ACG System was explored as a tool for identification, using its Aggregated Diagnosis Group (ADG) categories. ⋯ With this study, the ACG System has proven to be a useful tool in the identification of patients with complex care needs in primary care, opening up possibilities for tailored interventions of care management for this complex group of patients. Utilizing ADGs, the prediction model that we developed had a very good discriminatory ability to identify those complex patients. However, the calibrating ability of the model still needs improvement.
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Medigap protects traditional Medicare (TM) beneficiaries against catastrophic expenses. Federal regulations around Medigap enrollment and pricing are limited to the first 6 months after turning 65 years old. Eight states institute regulations that apply to later enrollment; half use community rating (charging everyone the same premium) and half use both community rating and guaranteed issue (requiring insurers to accept any beneficiary irrespective of health conditions). We examined the impact of state-level Medigap regulations on insurance coverage and health care spending for Medicare beneficiaries. ⋯ Our findings suggest a link between additional regulations and lower Medigap and higher MA enrollment. Policy makers should consider the potential effects on insurance coverage, premiums, financial protection, and moral hazard when designing Medigap regulations.
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To compare risk-adjusted 1-year mortality between Medicare Advantage (MA) and traditional Medicare (TM) enrollees with kidney failure who initiated dialysis. ⋯ Among Medicare beneficiaries with kidney failure who initiated dialysis, risk-adjusted 1-year mortality rate is not different between MA and TM stayers. If there is remaining favorable selection in MA due to unobserved health status, our finding provides a lower-bound estimate of the MA impact on mortality among beneficiaries with kidney failure.
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A variety of care coordination and delivery models have been used to address the social and medical needs of high-need, high-cost patient populations. However, the evidence on the effectiveness of such models is far from clear. The purpose of this study is to determine whether the Community Health Team (CHT) program, a community-based care management program in Rhode Island, had impacts on health care utilization and cost. ⋯ There is a need for a tailored approach to addressing patients' needs in primary care.
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As promising advances in providing care at home evolve, further research-with special attention to underserved populations-is needed to assess the clinical, equity, and economic impacts and to accelerate implementation where appropriate.