A novel intervention for Medicaid beneficiaries with complex needs

BACKGROUND: Case management interventions may improve outcomes for patients with complex medical and social needs, though previous research has shown mixed results. Enhanced Care Management (ECM), a central element of the California Advancing and Innovating Medi-Cal (CalAIM) initiative, aims to deliver an intensive case management solution for high-needs Medi-Cal (California's Medicaid program) members. 

OBJECTIVE: To evaluate a novel intervention that combines ECM, telemedicine, and integrated social care delivery from community-based organizations. DESIGN: Retrospective cohort study. 

PARTICIPANTS: Adult, ECM-eligible Medi-Cal members. 

INTERVENTION: Enrollment with Pair Team, a California-based medical group and ECM provider that combines ECM, telemedicine, and integrated social care delivery from community-based organizations. 

MAIN MEASURES: Engagement with program and healthcare, program implementation metrics, and mental health outcomes. Pre-post analyses compared data from the year post enrollment versus year prior. 

KEY RESULTS: The study included 568 patients (395 [69.5%] female; average age 42.8 years). Patients averaged 3.3 program interactions per month over one year of enrollment; 17.8% of interactions were with an RN or NP. Patients engaged with Pair Team within 30 days of discharge from an ED or inpatient visit in 94.3% of visits. Post-enrollment, 300 (52.7%) patients had an HbA1c lab record (127 [22.3%] pre-enrollment, p < 0.001) and 465 (81.7%) had a blood pressure reading (423 [74.3%] pre-enrollment, p = 0.003). Post-enrollment, there was a 21% increase in outpatient visits (RR = 1.21, 95% CI 1.13-1.29), a 52% reduction in ED visits (RR = 0.48, 95% CI 0.42-0.55) and a 26% reduction in inpatient visits (RR = 0.74, 95% CI 0.55-0.99). PHQ-9 decreased by 4.0 points (p < 0.001) between intake and follow-up. 

CONCLUSIONS: Study participants receiving ECM services were highly engaged with the program and in their healthcare, and experienced reductions in acute care utilization and depressive symptoms. This highlights the Pair model's potential in improving care for patients with complex needs.