Outcomes

Many self-funded plans use a variety of health interventions to coordinate care for chronically ill and complex populations. Telephonic case management has served as a cornerstone of many such population health programs. In this case study, a self-insured employer wanted an independent assessment of the return-on-investment (ROI) for its 3rd party care management program. The vendor, using a pre-post measurement technique, purported its program would achieve a 10:1 ROI. Although the plan found some cost savings after implementing the vendor program, the overall spending by “super users” continued to increase year-after-year. These results seemed at odds with the anticipated savings that should have been achieved if the vendor’s ROI claims were accurate. A study was undertaken to better understand why plan health care costs were still rising for a sub-set of the population.

Trajectory designed a retrospective study which created two comparable populations: The first included patients who received telephonic case management services who reached a high-cost threshold (“super users”) The second – identified in the same fashion from the prior year – was a similar group in terms of demographics and health conditions but did not receive telephonic case management services (the “referent group”).

While people who previously had been “super users” were much less likely to be “super users” after receiving a telephonic case management intervention, the ROI – now accurately measured by Trajectory –was less than the pre-post study result reported by the vendor. Specific findings for the group receiving telephonic case management (compared to the referent group) included: The average per person medical cost was $6,000 less annually; the cost of the case management program was approximately $3,000 per person. The actual ROI achieved for telephonic case management was 2:1 ($6,000 saved vs $3,000 spent), not the 10:1 claimed by the vendor. The company withdrew from the vendor program and brought case management in house, along with access to the Trajectory portal and consultation from the Trajectory team. Trajectory continued to provide secondary analyses, including risk scoring, reviews of individual patient factors (e.g., diagnoses, procedures, pharmacy utilization), and established feedback loops on medical trends and costs for “super-users.”

Trajectory determined the true ROI for a 3rd party case management program. These findings led to a replacement of the vendor product with an in-house care management program supported by Trajectory data analysis and consultation services which helped plan medical staff develop and implement customized care plans. These changes in strategy have continued to drive better clinical outcomes and cost savings.