Comprehensive care programs reduce costs in children with medical complexity

1. Enrollment in comprehensive care management programs for children with medical complexity (CMC) was associated with decreased inpatient, emergency department (ED), and overall healthcare spending.

2. Reductions were also seen in hospitals admissions, ED visits, and office visits for CMC in the comprehensive care group.

Evidence Rating Level: 2 (Good)

Study Rundown: Advancements in modern medical and surgical interventions have led to a dramatic increase in the number of children living with complex chronic medical conditions. These children disproportionally account for a large percentage of overall health care spending and usage. This multicenter study sought to determine whether comprehensive care management programs would be effective in reducing health care spending amongst CMC. It included data from 3885 CMC enrolled in comprehensive care management programs in 9 different children’s hospitals and compared them to a control group of CMC that were not enrolled in the comprehensive care clinics. After 2 years, the intervention group had a 4.6% reduction in per-member per-year (PMPY) spending. This decrease was seen across inpatient, outpatient, and ED spending. Overall, the study showed that enrollment in comprehensive care management programs, with the implementation of 4 key change concepts, led to reduced health care spending and usage amongst CMC. A key limitation of the study was its short duration of 2 years. Furthermore, the results may not be generalizable to CMC cared for by PCPs not associated with academic children’s hospitals.

Click to read the study, published today in Pediatrics

Click to read an accompanying editorial in Pediatrics

Relevant Reading: Children with medical complexity: an emerging population for clinical and research initiatives

In-Depth [prospective cohort]: This prospective cohort study analyzed Medicare and Medicaid data of CMC who participated in a National Learning Collaborative (LC) that consisted of complex care programs at children’s hospitals and their referring PCPs. CMC aged 0-18 years with diagnoses compatible with 3M Clinical Risk Group (CRG) categories 5b through 9 were included in the study. Propensity score matching generated a comparison group of 3885 of CMC who were similar in age, sex, and disease severity to the intervention group. The LC interventions consisted of 4 concepts: (1) establishment of a “dynamic care team” of providers 2) development of specific care plans (3) individualized access and contingency plans (4) a patient registry. Data was analyzed over a period of 24 months. The primary outcome was total PMPY expenditures. Secondary outcomes included inpatient admissions, ED visits, and office visits. Results showed decreases of 4.6% in overall PMPY spending, 7.7% in inpatient spending, and 11.6% in ED spending in the intervention group compared to the control group. CMC with more severe disease saw a smaller effect of the intervention (3.4% decrease in spending) compared to those with less severe chronic disease (4.1% decrease). Spending differed between age groups; statistically significant decreased spending was seen only in the group aged 6-11 years. Hospital admissions, ED visits, and office visits were decreased in the intervention group.

Image: PD

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