@article{b31070eaf87f407d90b63329eff97c3b,
title = "Key Design Considerations When Calculating Cost Savings for Population Health Management Programs in an Observational Setting",
abstract = "Objective: To illustrate the impact of key quasi-experimental design elements on cost savings measurement for population health management (PHM) programs. Data Sources: Population health management program records and Medicaid claims and enrollment data from December 2011 through March 2016. Study Design: The study uses a difference-in-difference design to compare changes in cost and utilization outcomes between program participants and propensity score-matched nonparticipants. Comparisons of measured savings are made based on (1) stable versus dynamic population enrollment and (2) all eligible versus enrolled-only participant definitions. Options for the operationalization of time are also discussed. Data Collection/Extraction Methods: Individual-level Medicaid administrative and claims data and PHM program records are used to match study groups on baseline risk factors and assess changes in costs and utilization. Principal Findings: Savings estimates are statistically similar but smaller in magnitude when eliminating variability based on duration of population enrollment and when evaluating program impact on the entire target population. Measurement in calendar time, when possible, simplifies interpretability. Conclusion: Program evaluation design elements, including population stability and participant definitions, can influence the estimated magnitude of program savings for the payer and should be considered carefully. Time specifications can also affect interpretability and usefulness.",
keywords = "Population health management, attrition, cost savings, intention-to-treat, program evaluation",
author = "Murphy, {Shannon M.E.} and Hough, {Douglas E.} and Sylvia, {Martha L.} and Dunbar, {Linda J.} and Frick, {Kevin D.}",
note = "Funding Information: Disclosures: The project described was supported by Grant number 1C1CMS331053 from the Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents of this publication are solely the responsibility of the authors and do not necessarily represent the official views of the U.S. Department of Health and Human Services or any of its agencies. The research presented here was conducted by the awardee. Findings might or might not be consistent with or confirmed by the findings of the independent evaluation contractor. Declaimer: None. Funding Information: The program evaluation framework is demonstrated using the Medicaid results from the Johns Hopkins Community Health Partnership (J-CHiP) community-based PHM program (Berkowitz et al. 2016; Hsiao et al. unpublished data). Supported by a Health Care Innovation Award (HCIA) from the Center for Medicare and Medicaid Innovation (CMMI), the PHM program component of J-CHiP was designed to improve health and reduce spending for high-risk Medicaid and Medicare populations in East Baltimore. The program aimed to achieve these goals by improving care coordination and addressing the clinical and social determinants of health. Care coordination teams were formed with site-embedded care managers and behavioral health specialists, community health workers, and neighborhood navigators. Publisher Copyright: {\textcopyright} Health Research and Educational Trust",
year = "2018",
month = aug,
doi = "10.1111/1475-6773.12832",
language = "English (US)",
volume = "53",
pages = "3107--3124",
journal = "Health Services Research",
issn = "0017-9124",
publisher = "Wiley-Blackwell",
}