Daniel Lessler, MD, MHA Chief Medical Officer Health Care Authority Evaluating Social and Economic Interventions for Complex Populations: A Policy Lens Daniel Lessler, MD, MHA Chief Medical Officer Health Care Authority

A Tale of Two Studies RCT of intensive care management Prospective cohort study of intensive care management with propensity matched comparison group Different target populations Similar interventions Both in Washington State, both among high need-high utilizing Medicaid patients

RCT of Intensive Care Management for Disabled WA Medicaid Beneficiaries with High Costs Objective: Evaluate outcomes (cost and utilization) of a community-based RN-led care management intervention for disabled Medicaid beneficiaries with high costs Design: RCT; administrative data linked to describe health services, criminal activity, homelessness and death; difference-in-differences; intention to treat analysis. Result: No cost savings in the target population Bell et al. Health Services Research 50:3 (June 2015)

Non-RCT Evaluation of an Intensive Care Management Program for WA Medicaid Beneficiaries with Disabilities Objective: Evaluate outcomes (cost, utilization, mortality) of an intensive RN care management program for high risk Medicaid beneficiaries with disabilities receiving in-home personal care Design: Prospective cohort; Difference-in-differences; propensity matched comparison group Result: Large and significant reductions in inpatient hospital costs Xing et al. Health Affairs. 2015: 34(4);653-661

Washington State Health Homes Funded in FY 13-14 as pilot “One of the major differences between the state’s Health Home model and Chronic Care Management program is that the Health Home model is available to a far broader population of high-risk Medicaid enrollees…it remains to be seen whether the results present here can be achieved in the broader health home population.” Xing et al. Health Affairs. 2015: 34(4);653-661

Complex Care Management: Policy Lens Health homes model for Medicaid now rolled out across WA state Required approval from the “authorizing environment” Subsequent evaluation of pilot demonstrated substantial cost savings Strength of evidence rubric important, but not definitive to informing policy direction Research context can identify a promising approach; this can be piloted in policy context

Policy Lens On Complex Care Management Evaluation: Future Directions Single year vs. multi-year evaluation Measure clinical and social outcomes (including patient reported outcomes) as well as cost/utilization outcomes Address fragmentation and duplication of complex care management services across sectors Re-calibrate “success”: from cost-saving to cost effective

Daniel Lessler, MD, MHA Chief Medical Officer Health Care Authority Daniel.Lessler@hca.wa.gov