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Med Care. 2018 Jul;56(7):603-609. doi: 10.1097/MLR.0000000000000934.

Going Beyond Clinical Care to Reduce Health Care Spending: Findings From the J-CHiP Community-based Population Health Management Program Evaluation.

Author information

1
Johns Hopkins HealthCare LLC, Glen Burnie.
2
Johns Hopkins University Bloomberg School of Public Health, Baltimore, MD.
3
Medical University of South Carolina, College of Nursing, Charleston, SC.
4
Johns Hopkins Community Physicians, Medical Affairs.
5
Johns Hopkins University School of Medicine.
6
Johns Hopkins University Carey Business School, Baltimore, MD.

Abstract

BACKGROUND:

Addressing both clinical and nonclinical determinants of health is essential for improving population health outcomes. In 2012, the Johns Hopkins Community Health Partnership (J-CHiP) implemented innovative population health management programs across acute and community environments. The community-based program involved multidisciplinary teams [ie, physicians, care managers (CM), health behavior specialists (HBS), community health workers, neighborhood navigators] and collaboration with community-based organizations to address social determinants.

OBJECTIVES:

To report the impact of a community-based program on cost and utilization from 2011 to 2016.

DESIGN:

Difference-in-difference estimates were calculated for an inclusive cohort of J-CHiP participants and matched nonparticipants. The analysis was replicated for participants with a CM and/or HBS to estimate the differential impact with more intensive program services.

SUBJECTS:

A total of 3268 high-risk Medicaid and Medicare beneficiaries (1634 total J-CHiP participants, 1365 with CM and 678 with HBS).

OUTCOME MEASURES:

Paid costs and counts of emergency department visits, admissions, and readmissions per member per year.

RESULTS:

For Medicaid, costs were almost $1200 per member per year lower for participants as a whole, $2000 lower for those with an HBS, and $3000 lower for those with a CM; hospital admission and readmission rates were 9%-26% lower for those with a CM and/or HBS. For Medicare, costs were lower (-$476), but utilization was similar or higher than nonparticipants. None of the observed Medicaid or Medicare differences were statistically significant.

CONCLUSIONS:

Although not statistically significant, the results indicate a promising innovation for Medicaid beneficiaries. For Medicare, the impact was negligible, indicating the need for further program modification.

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