Health care providers are under pressure to manage costs while maintaining high-quality care. One potential solution is the use of care management programs, which provide personalized services to patients who suffer a high burden of chronic disease. These programs aim to help patients maintain good health, avoid hospitalization or institutionalization, and reduce health care costs.
To help coordinate care for high-risk patients, the state of Rhode Island contracted with the RIPIN, a community-based organization that helps Rhode Islanders access healthcare, health insurance or special education for children with disabilities. The RI-RIPIN care management program was evaluated over a two-year period by researchers from the Brown University School of Public Health, Columbia University Mailman School of Public Health, and University of Vermont Health Network. Their study, “Evaluating a Care Management Program for Dual-Eligible Beneficiaries: Evidence from Rhode Island,” was recently published in Population Health Management.
The study analyzed the data of 169 participants from 2017 to 2019. Participants were likely to suffer from chronic illnesses, most commonly heart and kidney disease, anemia, diabetes and depression. The results showed that participants in the RI-RIPIN program experienced significantly fewer hospital admissions and reduced Medicare and Medicaid costs than non-participants. Participation also allowed for greater access to medical equipment and long-term services.
“We found that the services provided by RIPIN's community health workers led to significant reductions in hospital admissions and Medicaid spending,” said David Meyers, assistant professor of health services, policy and practice, and a lead author of the study. “This finding is significant as RIPIN's clients often face substantial barriers in getting access to care and social services, and it is clear that the intervention worked.”
The authors acknowledge that the program did not result in a significant decrease in emergency department visits, and note that the study has some limitations, such as the absence of random selection for program participation. Despite these qualifications, the authors observed that community-based care management led to notable reductions in unnecessary health care utilization and costs, and a noticeable improvement in the quality of life for individuals with special needs.
“From what we hear from our patients everyday, we know that our community health workers are making a difference with these vulnerable, low-income, older and disabled adults,” said Sam Salganik, RIPIN’s Executive Director. “The connections we form with clients help them to live healthier lives, in their respective communities, which is what this population prefers. Thanks to our partnership with Brown, we now have the data and analysis to show that our intervention was successful.”
“While our evaluation was done independently,” Meyers said, “it was designed with RIPIN, who know best about what outcomes are most important to their patients.” Meyers noted that collaborating with RIPIN to evaluate their program is an example of connecting researchers with community organizers to improve public health: “It was a terrific experience working with RIPIN and a great opportunity to conduct rigorous empirical research with an organization that is actually working in our community.”