Care coordination was provided by nurse and physician services through the existing complex case management employees. Alert programming was established by the Medical Director in association with discussions with primary care provider, specialty providers, and evidence based care guidelines. Alert prompts were sent to nurse care coordinators via email and texts. Nurse coordinators contacted patients in response to alert prompts and on a regular schedule during the trial. Face to face patient interaction with the care coordination team was not required but often transpired during the trial. Patients were able to participate remotely, through face to face interactions in the care coordination clinic, or through face to face home interactions.
Results
Cost of care was reduced by $221,570 for the 20 patients in this 180 day trial. This equates to an average of $11,078 in cost reduction for each patient in the trial. Appendices 1-6 detail pre and post-trial costs of care and sites of utilization. Cost reductions were realized through reduced Emergency Room and Urgent Care visits, reduced specialty visits, and reduced hospital admissions. The reduction in hospital admissions was achieved largely through reduced readmissions. The table below summarizes utilization for trial members. The use of CYTTA Connect Ecosystem during this trial reduced utilization in the initial 90 days, but produced even more dramatic reductions in the second 90 day period. This supports the belief that patients began to learn how to better self-manage their conditions as they became familiar with the program and their care coordinators. The average reimbursement for a hospital inpatient DRG was estimated at $22,000; Emergency room visits average $1,200.00/visit; specialty physician visits average $125/visit while urgent care visits average $90/visit.
Special note is made regarding 3 unavoidable hospital admissions with prolonged inpatient stays.
1. A member with no prior history of upper gastrointestinal bleeding developed abrupt hematemesis in addition to their diagnosis of end stage idiopathic pulmonary fibrosis. The member was admitted and spent 9 days in the hospital with a bleeding gastric ulcer.
2. A dialysis member with narcotic dependency, diabetes, and advanced degenerative spinal disease suffered a traumatic neck injury resulting in a 69 day stay and quadriplegia.
3. A member with idiopathic cardiomyopathy developed left ventricular assist device infection requiring hospital admission, LVAD removal, placement of an intra-aortic balloon pump and continued inpatient stay until a heart was found and heart transplantation completed. This resulted in a 73 day inpatient stay.
Summary of Trial results
---------------------------------------------------------------------------- Last 90 days Pre-trial Post-trial of trial Change Cost Savings----------------------------------------------------------------------------Admits 28 17 3 9 $198,000----------------------------------------------------------------------------Readmits 12 5 0 7 $140,000----------------------------------------------------------------------------Bed Days 90 143 80 (53)----------------------------------------------------------------------------ER Visits 44 26 4 18 $21,600----------------------------------------------------------------------------UC Visits 12 4 1 8 $720----------------------------------------------------------------------------Specialists 102 92 36 10 $1,250----------------------------------------------------------------------------PCP 92 78 18 14 Capitated----------------------------------------------------------------------------Total Cost Savings $221,570----------------------------------------------------------------------------Cost Savings per Member over 6 months $11,078----------------------------------------------------------------------------Cost savings per Member per month $1,846----------------------------------------------------------------------------
