1. 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

2. 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

3. 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)

4. 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);

5. Washington State Health Homes
Funded in FY 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);

6. 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

7. 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

8. Daniel Lessler, MD, MHA Chief Medical Officer Health Care Authority