Does an all-condition case management program for high-risk patients reduce health care utilization in medicaid and medicare beneficiaries with diabetes?

Objective: To assess whether an all-condition case management program can improve health care utilization and clinical outcomes in patients with diabetes. Research design and methods: 1342 patients with diabetes were enrolled in the Johns Hopkins Community Health Partnership (J-CHiP)Case Management program for high-risk patients with any chronic disease. We categorized participants into two intervention exposure categories based on the number of contacts with case manager (CM)and community health worker (CHW)per month: low contact (≤1 contact/month), and high contact (>1 contacts/month). The primary outcomes were rates of emergency department (ED)visits, hospitalizations, and 30-day hospital readmissions. Results: In analyses adjusted for age, sex, race, risk score, and baseline health utilization rate, Medicaid participants in the high contact group had 42% (rate ratio (RR): 1.42; 95% CI: 1.08–1.86)and 64% (RR: 1.64; 95% CI: 1.08–2.48)higher risks for hospital admission and readmission, respectively, than the low contact group. Similar increases were seen in the Medicare participants with 20% (RR: 1.20; 95% 1.02–1.42)and 42% (RR:1.42; 95% 1.09–1.84)higher risks for admission and readmission, respectively. The associations were not statistically significant for ED visits. Subsidiary analysis of a subset with HbA1c available (n = 545)revealed a statistically significant decrease in HbA1c among Medicare participants (mean (SD): −0.17% (1.50%)), with a larger decrease in the high contact group (mean (SD): −0.23% (1.59%)). Conclusion: In an all-condition case management program for high-risk patients, the higher intensity of contacts with CHW and CM was not associated with a reduced health care utilization in adults with diabetes.