Health systems across the country are looking to achieve the triple aim of improving population health and patient outcomes while simultaneously lowering cost. Many health policy experts see identifying high cost patients (sometimes referred to as “super-utilizers”) and targeting interventions designed to reduce their hospital and emergency department use as an important strategy given super-utilizers can account for up to 80% of total costs in a population. Many organizations are looking to the Camden model which relies on a team of nurses, community health workers, social workers and others to support high cost patients in better engaging in their care and in addressing housing, transportation and other challenges that make it more difficult to manage chronic diseases effectively, thereby leading to potentially avoidable hospitalizations and emergency room visits. Yet, evidence is still fairly limited as to whether this model does lead to lower utilization of high cost services.
A new study by Mathematica Policy Research investigated the effectiveness of a high-intensity care management program that the Rutgers University Center for State Health Policy (CSHP) implemented as an adaptation of the Camden model, which was developed by the Camden Coalition of Healthcare Providers. The research team evaluated the outcomes of super-utilizer Medicare beneficiaries at four provider groups that employed the Camden model and found the patients had 37% fewer 30-day unplanned hospital readmissions than the comparison group. While the other outcomes were less conclusive, they point to the potential for this model to demonstrate cost savings with larger samples.
“These results are very exciting because at a minimum, this study shows these types of interventions do not lead to higher Medicare spending and in fact, could be leading provider groups to ‘spend better’ if not less,” says Clese Erikson, Deputy Director of the George Washington University Milken Institute School of Public Health Health Workforce Research Centers on Emerging Health Workforce Issues and Health Equity in Health Professions Education and Training. “By connecting patients with community resources to address housing needs, food insecurity and other social determinants of health, they are likely having a significant positive impact on the patients’ quality of life that are not captured in Medicare claims data.”
Erikson points out that more research is necessary to evaluate the Camden approach’s utility and value, including the impact that training on this model has on the career paths of physicians, nurses, social workers and other health professions students. The GW Health Workforce Institute was recently funded by the Health Resources Services Administration (HRSA) to study whether health professions students who participated in a six-month inter-professional service learning experience using the Camden model state it helped them to better understand how other health professions can contribute to patient care, feel better prepared to address social determinants of health, and more likely to seek careers where they can focus on underserved populations. Erikson adds, “As we continue to move toward value-based care models that focus on population health, identifying training models that provide students with the skills and training to care for complex patients as part of inter-professional teams will be in increasingly high demand.”
“Effects of a Community-Based Care Management Model for Super Utilizers” is published in The American Journal of Managed Care.