Medical Care最新文献

{"title":"Defining and Validating Criteria to Identify Populations Who May Benefit From Home-Based Primary Care.","authors":"Maggie R Salinger, Katherine A Ornstein, Hannah Kleijwegt, Abraham A Brody, Bruce Leff, Harriet Mather, Jennifer Reckrey, Christine S Ritchie","doi":"10.1097/MLR.0000000000002085","DOIUrl":"10.1097/MLR.0000000000002085","url":null,"abstract":"<p><strong>Background: </strong>Home-based primary care (HBPC) is an important care delivery model for high-need older adults. Currently, target patient populations vary across HBPC programs, hindering expansion and large-scale evaluation.</p><p><strong>Objectives: </strong>Develop and validate criteria that identify appropriate HBPC target populations.</p><p><strong>Research design: </strong>A modified Delphi process was used to achieve expert consensus on criteria for identifying HBPC target populations. All criteria were defined and validated using linked data from Medicare claims and the National Health and Aging Trends Study (NHATS) (cohort n=21,727). Construct validation involved assessing demographics and health outcomes/expenditures for selected criteria.</p><p><strong>Subjects: </strong>Delphi panelists (n=29) represented diverse professional perspectives. Criteria were validated on community-dwelling Medicare beneficiaries (age ≥70) enrolled in NHATS.</p><p><strong>Measures: </strong>Criteria were selected via Delphi questionnaires. For construct validation, sociodemographic characteristics of Medicare beneficiaries were self-reported in NHATS, and annual health care expenditures and mortality were obtained via linked Medicare claims.</p><p><strong>Results: </strong>Panelists proposed an algorithm of criteria for HBPC target populations that included indicators for serious illness, functional impairment, and social isolation. The algorithm's Delphi-selected criteria applied to 16.8% of Medicare beneficiaries. These HBPC target populations had higher annual health care costs [Med (IQR): $10,851 (3316, 31,556) vs. $2830 (913, 9574)] and higher 12-month mortality [15% (95% CI: 14, 17) vs. 5% (95% CI: 4, 5)] compared with the total validation cohort.</p><p><strong>Conclusions: </strong>We developed and validated an algorithm to define target populations for HBPC, which suggests a need for increased HBPC availability. By enabling objective identification of unmet demands for HBPC access or resources, this algorithm can foster robust evaluation and equitable expansion of HBPC.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"27-37"},"PeriodicalIF":3.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11617084/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142469508","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hospital-Level Variation in COVID-19 Treatment Among Hospitalized Adults in the United States: A Retrospective Cohort Study.","authors":"G Caleb Alexander, Brian T Garibaldi, Huijun An, Kathleen M Andersen, Matthew L Robinson, Kunbo Wang, Yanxun Xu, Joshua F Betz, Albert W Wu, Arielle Fisher, Shanna A Egloff, Kenneth E Sands, Hemalkumar B Mehta","doi":"10.1097/MLR.0000000000002086","DOIUrl":"10.1097/MLR.0000000000002086","url":null,"abstract":"<p><strong>Study design: </strong>Retrospective cohort study.</p><p><strong>Objective: </strong>To characterize variation in dexamethasone and remdesivir use over time among hospitals.</p><p><strong>Background: </strong>Little is known about hospital-level variation in COVID-19 drug treatments in a large and diverse network in the United States.</p><p><strong>Methods: </strong>We selected individuals hospitalized with COVID-19 across 163 hospitals between February 23, 2020 and October 31, 2021 from using the HCA CHARGE, an electronic health record repository from a network of community health care facilities in the United States. We quantified receipt of dexamethasone, remdesivir, and combined use of dexamethasone and remdesivir during the hospital stay. We used 2-level logistic regression models to determine the intraclass correlation coefficient (ICC) at the hospital level, adjusting for patient and hospital characteristics. The ICC shows the proportion of total variation in drug use accounted for by hospitals.</p><p><strong>Results: </strong>Among 161,667 individuals hospitalized with COVID-19, 73.0% were treated with dexamethasone, 49.1% with remdesivir, and 45.0% with both dexamethasone and remdesivir. The proportion of variation in dexamethasone use was 12.7% (adjusted ICC: 0.127), 8.5% for remdesivir, and 11.3% for combined drug use, indicating low interhospital variation. In the fully adjusted models, between-facility variation in dexamethasone use declined from 34.1% in February-March 2020 to 11.3% in January-March 2021 and then increased to 17.3% in July-October 2021. The variation in remdesivir use remained relatively stable during the study period.</p><p><strong>Conclusions: </strong>During the first 2 years of the pandemic, there was relatively consistent use of dexamethasone and remdesivir across the hospitals examined. Consistent adoption and implementation of treatment guidelines across the hospitals examined may have led to a decrease in variation in drug usage over time.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"9-17"},"PeriodicalIF":3.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11624058/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142469509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Oncology Physician Turnover in the United States Based on Medicare Claims Data.","authors":"Sarah L Cornelius, Andrew Schaefer, Anna N A Tosteson, Alistair James O'Malley, Sandra L Wong, Erika L Moen","doi":"10.1097/MLR.0000000000002080","DOIUrl":"10.1097/MLR.0000000000002080","url":null,"abstract":"<p><strong>Objective: </strong>Physician turnover rates are rising in the United States. The cancer workforce, which relies heavily on clinical teamwork and care coordination, may be more greatly impacted by turnover. In this study, we aimed to characterize oncologists who move to identify targets for recruitment and retention efforts.</p><p><strong>Methods: </strong>We identified medical, radiation, and surgical oncologists who treated Medicare beneficiaries diagnosed with breast, colorectal, or lung cancer in 2016-2019. We used multivariable logistic regression to identify physician-level and multivariable multinomial regression to identify region-level characteristics associated with turnover. Measures included demographic, practice, and patient-sharing network characteristics.</p><p><strong>Results: </strong>Our cohort included 25,012 medical, radiation, and surgical oncologists, of which, 1448 (5.8%) moved. Women [vs men; odds ratio (OR): 1.46; 95% CI: 1.30-1.64] and surgeons (vs medical oncologists; OR: 1.17; 95% CI; 1.04-1.33) had higher odds of moving. Compared with oncologists with moderate patient-sharing ties, those with many ties had lower odds of moving (OR: 0.55; 95% CI: 0.43-0.70). Patient-sharing networks with low efficiency (vs moderate) were more likely to have a net loss in their oncology workforce (OR: 3.06; 95% CI: 1.12-8.35), whereas those with low specialist vulnerability (vs moderate) were less likely to have a net loss (OR: 0.32; 95% CI: 0.1-0.99).</p><p><strong>Conclusions: </strong>This study identified novel patient-sharing network characteristics associated with turnover, providing new insights into how the structural features of patient-sharing networks may be related to the recruitment and retention of oncologists.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":"63 1","pages":"62-69"},"PeriodicalIF":3.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11617083/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142789648","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Plan of Care Visits: Implementation During Hospitalization and Association With 30-Day Readmissions in a Large, Integrated Health Care System.","authors":"Steven P Masiano, Susannah Rose, Judith Wolfe, Nancy M Albert, Alex Milinovich, Leslie Jurecko, Beri Ridgeway, Michael W Kattan, Anita D Misra-Hebert","doi":"10.1097/MLR.0000000000002081","DOIUrl":"10.1097/MLR.0000000000002081","url":null,"abstract":"<p><strong>Background: </strong>Plan of Care of Visits (POCV), including the patient, nurse, and hospital provider were implemented across an integrated health system to improve provider-patient communication during hospitalization and patient outcomes.</p><p><strong>Objectives: </strong>To assess POCV adoption after implementation, patient characteristics assosites were classified as teachsites were classified as teachsites were classified as teachsites were classified as ciated with POCV completion, and association of POCV with 30-day readmissions.</p><p><strong>Methods: </strong>This retrospective cohort study utilized electronic medical record (EMR) data of 237,430 adult patients discharged to home from 11 hospitals from January 2020 to December 2022. POCV completion was a discrete EMR variable. POCV adoption was estimated monthly by hospital as proportion of patients with at least 1 POCV during hospitalization, with variation among hospitals measured using the Variance Partition Coefficient (VPC). Multivariable logistic regressions assessed factors associated with POCV completion and POCV association with 30-day readmission.</p><p><strong>Results: </strong>POCV adoption increased from 69% to 94% (2020-2022) and varied by 50% across hospitals (VPC 0.50, 95% CI: 0.29-0.70). Odds of a discharge-day POCV were lower among older patients (≥65 vs. 18-34 y, OR 0.81, CI: 0.79-0.83), and higher among female (OR 1.06; CI: 1.04-1.07), Asian (vs. White, OR 1.13; CI: 1.06-1.21), Hispanic (OR 1.09; CI: 1.05-1.13), and surgical patients (vs. medical, OR 1.33; CI: 1.30-1.35). Patients completing discharge-day POCV had lower 30-day readmission odds (2022 OR 0.76, CI: 0.73-0.79). Patients with POCV on ≥75% of hospital days had similar readmission odds trends.</p><p><strong>Conclusions: </strong>POCV implementation was successful, and POCV completion was associated with fewer 30-day readmissions. Future work should focus on increasing POCV adoption while reducing hospital variation.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"52-61"},"PeriodicalIF":3.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142469512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quebec Health-Related Quality-of-Life Population Norms Using the Health Utilities Index Mark 3: Stratification by Sociodemographic Data and Health Problems.","authors":"Thomas G Poder, Irène Dohouin","doi":"10.1097/MLR.0000000000002100","DOIUrl":"10.1097/MLR.0000000000002100","url":null,"abstract":"<p><strong>Objectives: </strong>To provide population utility norms from the Health Utilities Index Mark 3 (HUI3) for the province of Quebec, Canada.</p><p><strong>Methods: </strong>This study used data from the Care Trajectories Enriched Data (TorSaDE) cohort, which combines data from the Canadian Community Health Survey (CCHS) and the Quebec Provincial Insurance Board [Régie de l'assurance maladie du Quebec (RAMQ)]. The CCHS is a multiround health-related survey conducted by Statistics Canada since 2007. For each round spanning over 2 years, respondents were randomly selected and completed an online questionnaire. Quebec data for the HUI3 were available in the CCHS for rounds 2007, 2009, and 2013. The RAMQ database is an administrative database that contains information on health care services use and medical diagnostics. HUI3 scores were stratified by sociodemographic variables, as well as by self-reported health problems in the CCHS and by medical diagnostics from the RAMQ. Medical diagnostics were retrieved for the CCHS completion year and the year before and identifiable with the ICD-9 code in the RAMQ database.</p><p><strong>Results: </strong>A total of 55,656 individuals were considered in this analysis. The mean (95% CI) and the median interquartile range of HUI3 were respectively 0.919 (0.918-0.919) and 0.973 (0.905-1) for the entire population. Individuals with lower scores were females, those aged 75 and over, divorced or widowed, unemployed during the last 12 months, less educated, or with a lower annual household income. Individuals born abroad and with normal weight of body mass index had higher utility scores. HUI3 score decreased with the number of diagnosed diseases from 0.946 (0.946-0946) for individuals without diagnosed disease to 0.682 (0.678-0.686) for individuals diagnosed with up to 18 diseases. Regardless of the number of diagnosed diseases in the RAMQ database, individuals who self-reported suffering from a single health problem presented a significantly lower HUI3 ranging from 0.944 (0.943-0.944) for Asthma to 0.789 (0.782-0.796) for Alzheimer compared with 0.956 (0.956-0.957) for individuals with no reported health problems. The same pattern was observed when considering individuals regardless of the diagnosed and self-reported diseases.</p><p><strong>Conclusion: </strong>Utility score norms for HUI3 were produced in the general population of Quebec. Significant differences among various health problems were identified and norms can be used to compare populations in studies that do not have a control group.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":" ","pages":"43-51"},"PeriodicalIF":3.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142682269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The State of Medical Care for Adults With Intellectual and/or Developmental Disabilities.","authors":"David A Ervin","doi":"10.1097/MLR.0000000000001977","DOIUrl":"10.1097/MLR.0000000000001977","url":null,"abstract":"<p><p>For more than 2 decades, medical care for adults with intellectual and/or developmental disabilities (IDDs) has been difficult to access and has not substantially changed the persistently poor health status that is common in this population cohort. While there has been some progress in the development of models of care that are designed with and for adults with IDD, it has been slow and sporadic, with little data or analyses of efficacy or effectiveness. Very few medical schools and other health science professional education in the United States include curricular content on adults with IDD, resulting in health care practitioners being under or altogether unprepared to provide care to them. Public and private health care policy and financing are not responsive to the medical care needs and experiences of adults with IDD. More recently, the impact of the COVID-19 pandemic on adults with IDD was disproportionally more severe, with significantly higher rates of morbidity and mortality than on adults without IDD, having nothing to do with the presence of an IDD itself. This commentary reviews persistent barriers to accessible, responsive medical care for adults with IDD and reviews a number of health care models that have been developed since the turn of the 21st century. It also offers a brief review of Medicaid Managed Care as a potential policy and financing solution to long-standing financing and related obstacles to optimal medical care.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":"63 1 Suppl 1","pages":"S1-S7"},"PeriodicalIF":3.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142789469","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality of Medical Care for Adults With Intellectual/Developmental Disabilities.","authors":"","doi":"10.1097/MLR.0000000000002104","DOIUrl":"10.1097/MLR.0000000000002104","url":null,"abstract":"","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":"63 1 Suppl 1","pages":"i"},"PeriodicalIF":3.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142789467","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Innovation in Medical Education on Intellectual/Developmental Disabilities: Report on the National Inclusive Curriculum for Health Education-Medical Initiative.","authors":"Priya Chandan, Emily J Noonan, Kayla Diggs Brody, Claire Feller, Emily Lauer","doi":"10.1097/MLR.0000000000002079","DOIUrl":"10.1097/MLR.0000000000002079","url":null,"abstract":"<p><p>The lack of physician training in serving patients with intellectual and developmental disabilities (IDDs) has been highlighted as a key modifiable root cause of health disparities experienced by this high-priority public health population. To address gaps in medical education regarding the lack of IDD curriculum, lack of evaluation/assessment, and lack of coordination across institutions, the American Academy of Developmental Medicine and Dentistry created the National Inclusive Curriculum for Health Education-Medical (NICHE-MED) Initiative in 2016. The aims of NICHE-MED are to: (1) impact medical students' attitudes and/or knowledge to address underlying ableism and address how future physicians think about disability; (2) apply a lens of health equity and intersectionality, centering people with IDD, but fostering conversation and learning about issues faced by other disability and minoritized populations; and (3) support community-engaged scholarship within medical education. As of 2024, the NICHE-MED initiative consists of close to 40 Medical School Partners, each with their own community-engaged disability curriculum intervention paired with a rigorous evaluation that ties centrally to coordinated program evaluation. The NICHE-MED initiative demonstrates implementation success at scale and is a successful community-engaged curriculum change model that may be replicated regarding disability more broadly and regarding necessary medical education efforts that center other marginalized populations.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":"63 1 Suppl 1","pages":"S25-S30"},"PeriodicalIF":3.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11617082/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142789652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Health System Expansion and Changes in Medicare Beneficiary Utilization of Safety Net Providers.","authors":"Kun Li, José J Escarce, Shiyuan Zhang, Denis Agniel, Maria DeYoreo, Justin W Timbie","doi":"10.1097/MLR.0000000000002083","DOIUrl":"https://doi.org/10.1097/MLR.0000000000002083","url":null,"abstract":"<p><strong>Background: </strong>Evidence is limited on insured patients' use of safety net providers as vertically integrated health systems spread throughout the United States.</p><p><strong>Objectives: </strong>To examine whether market-level health system penetration is associated with: (1) switches in Medicare beneficiaries' usual source of primary care from federally qualified health centers (FQHCs) to health systems; and (2) FQHCs' overall Medicare patient and visit volume.</p><p><strong>Research design: </strong>Beneficiary-level discrete-time survival analysis and market-level linear regression analysis using Medicare fee-for-service claims data from 2013 to 2018.</p><p><strong>Subjects: </strong>A total of 659,652 Medicare fee-for-service beneficiaries aged 65 and older lived in one of 27,386 empirically derived primary care markets whose usual source of care in 2013 was an FQHC or a non-FQHC-independent physician organization that predominantly served low-income patients.</p><p><strong>Measures: </strong>Beneficiary-year measure of the probability of switching to health system-affiliated physician organizations and market-year measures of the number of FQHC visits by Medicare beneficiaries, number of beneficiaries attributed to FQHCs, and FQHC Medicare market shares.</p><p><strong>Results: </strong>During 2013-2018, 16.5% of beneficiaries who sought care from FQHCs switched to health systems. When health system penetration increases from the 25th to 75th percentile, the probability of Medicare FQHC patient switching increases by 4.6 percentage points, with 22 fewer Medicare FQHC visits and 4 fewer beneficiaries attributed to FQHCs per market year. Complex patients and patients who sought care from non-FQHC, independent physician organizations exhibited higher rates of switching to health systems.</p><p><strong>Conclusions: </strong>Health system expansion was associated with the loss of Medicare patients by FQHCs, suggesting potential negative spillovers of vertical integration on independent safety net providers.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":"63 1","pages":"18-26"},"PeriodicalIF":3.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142789644","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost-effectiveness of a Low-cost Educational Messaging and Prescription-fill Reminder Intervention to Improve Medication Adherence Among Individuals With Intellectual and Developmental Disability and Hypertension.","authors":"Brian Chen, Suzanne McDermott, Deborah Salzberg, Wanfang Zhang, James W Hardin","doi":"10.1097/MLR.0000000000001946","DOIUrl":"10.1097/MLR.0000000000001946","url":null,"abstract":"<p><strong>Background: </strong>Adults with intellectual and developmental disabilities (IDDs) have a similar prevalence of hypertension as the general population, but a higher rate of medication nonadherence at 50% compared with the average of 30%.</p><p><strong>Objectives: </strong>To assess the cost-effectiveness of educational messaging and prescription-fill reminders to adults with IDD and hypertension and their helpers among Medicaid members in a randomized control trial.</p><p><strong>Research design: </strong>The authors calculated net cost savings by subtracting per-participant intervention costs from differences in spending between preintervention/postintervention cases versus controls. Using bootstrap samples, they assessed the probability of positive cost savings. They used quantile and logistic regression to examine which members contributed to the cost savings and to identify future high-cost members at baseline.</p><p><strong>Subjects: </strong>Four hundred twelve members with IDD and their helpers were recruited from the South Carolina Medicaid agency in 2018.</p><p><strong>Measures: </strong>Intervention costs were determined using labor and communication costs. Health expenditures were obtained from South Carolina's all-payer claims database, using actual Medicaid expenditures and total all-payer expenditures estimated with cost-to-charge ratios.</p><p><strong>Results: </strong>The intervention, which cost $26.10 per member, saved $1008.02 in all-payer spending and $1126.42 in Medicaid payments per member, respectively, with 78% and 91% confidence. Cost savings occurred among members above the 85th percentile of spending, and those using the emergency department or inpatient services at least twice at baseline were predicted to be future high-cost members.</p><p><strong>Conclusions: </strong>The intervention is cost-saving, and insurers can prospectively identify and target members who will likely benefit.</p>","PeriodicalId":18364,"journal":{"name":"Medical Care","volume":"63 1 Suppl 1","pages":"S15-S24"},"PeriodicalIF":3.3,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11617081/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142789650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}