Data: Remote Care Management Lowered Hospital Visits, Health Costs for High-Risk Medicare Beneficiaries with Chronic Conditions

WASHINGTON, July 31, 2020 /PRNewswire/ -- Done right, remote health advising and other care management interventions can significantly reduce hospitalizations and medical spend for high-risk Medicare beneficiaries, Evolent Health (NYSE: EVH) experts report in the July issue of The American Journal of Managed Care.

Across Evolent partners in five regions, inpatient admissions were 21% lower and total medical spend was 22% lower for high-risk members who engaged in care management programs versus high-risk members who did not. Additionally, those reductions were roughly twice as large among "high fidelity" patients—those who engaged more deeply in the care management program. Among these patients, readmissions were 47% lower and medical spend was 42% lower than high-risk patients who did not participate.

Nearly all care management interactions—96%—took place over the telephone, an encouraging fact in an age of COVID-19-related social distancing.

"Seniors with chronic conditions often have limited health support once they leave the physician's office. Care management closes gaps and helps these individuals manage their diseases to avoid serious—and costly—complications," said Evolent Chief Innovation Officer Dr. Anita Cattrell, the study's principal investigator. "Clinicians also value care management. The disease education and care coordination that we provide allows them to focus on what they do best—diagnosing, treating and managing disease—while increasing their capacity to manage larger patient panels."

The study evaluated Evolent's Complex Care program, which targets Medicare beneficiaries with multiple chronic diseases, across five Medicare accountable care organizations from 2016 through 2017.

High-risk individuals were identified using Evolent's predictive analytics, tapping into a diverse data set—clinical conditions, recent health care utilization, lab results, prescriptions, demographics and social determinants of health—to identify patients most likely to have preventable hospitalizations in the next six months. Also, about 13% of high-risk patients were referred by their physicians. Notably, those referred in by predictive analytics had better outcomes after enrolling in care management, presumably because physicians often referred patients whose health had already deteriorated, while Evolent's algorithm anticipated future problems to disrupt them earlier.

Those who agreed to participate in care management were paired with an Evolent Care Advisor, a care management specialist with a background in nursing or social work. The Care Advisor worked with the patient, providers and extended care team to develop an individualized care plan focused on six key mechanisms: identifying and mitigating barriers to improved health; improving care coordination; closing care gaps such as missing vaccinations; ensuring medication lists are accurate and up to date; educating patients and engaging them to independently manage their health; and making referrals to local or electronic resources, such as social services.

On average, program participation lasted four months. Patients "graduated" from the program if all health barriers were resolved.

Evolent's analysis followed nearly 1,900 high-risk care management participants for six months after they enrolled in the program. To form a control group, each of these patients was matched with a non-participant with a similar disease profile, predictive risk score, medical cost and utilization.

In addition to comparing participants versus non-participants, the Evolent team sought to understand whether those patients who met key program benchmarks, such as having at least two structured clinical sessions per month and achieving a specific set of program goals, had better outcomes. These high-fidelity patients made up nearly 75% of care management participants.

"It's important not only to show that your care management program is working, but to understand why so you can replicate that success," Cattrell said. "Through this study we identified several key indicators that a program can monitor and measure to see whether patients are reaching their milestones and getting a high-quality care management experience. As the study showed, when we can check those boxes, it translates to fewer hospitalizations and lower spending."

About Evolent Health
Evolent Health (NYSE: EVH) delivers proven clinical and administrative solutions that improve whole-person health while making health care simpler and more affordable. Our solutions encompass total cost of care management, specialty care management, and administrative simplification. Evolent serves a national base of leading payers and providers, is the first company to receive the National Committee for Quality Assurance's Population Health Program Accreditation, and is consistently recognized as a top place to work in health care nationally. Learn more about how Evolent is changing the way health care is delivered by visiting evolenthealth.com.

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