Storm Clouds on the Horizon - Expected Adverse Selection in Medicare Prescription Drug Plans
- Presenter:
Chair: Carole Gresenz; Discussant: Bill Encinosa Wed June 7, 2006 8:00-9:30 Room 235
Objective: To estimate the costs and benefits from a Neonatal Intensive Care Unit (NICU) case management program. Background: Starting in 2005 ParadigmHealth (PH) began administering its NICU case management program for Blue Shield of California (BSC) members. During the 2 years prior there was no NICU case management program in place. This program assigns a NICU-trained RN case manager to each enrolled patient. The on-site RN case manager consults with ParadigmHealth’s neonatologists. The PH team works with the hospital’s neonatology staff to develop a treatment plan using evidence-based guidelines. In addition PH provides patient education and creates a post-discharge plan with the family. PH receives a regular data feed from the BSC inpatient authorization system. Patients are enrolled 2-3 days after admission to the NICU. This program is expected to reduce the initial length of stay as well as reduce readmissions. Methodology: This program was implemented system-wide in January 2005, with no control group. However BSC NICU data was available during a two-year period prior to program implementation (2003-2004). To control for possible differences in case-mix across time we stratified the cases into 21 groups. There were seven birth weight categories and three clinical groups (surgical, congenital abnormalities or respiratory distress, and other complications). 2015 NICU cases were included in the baseline analysis. Cases that were discharged within 3 days of admission and cases with missing or conflicting birth weight observations were excluded. There are also several clinical exclusions from the program. These conditions (such as transplant surgery and extracorporeal membrane oxygenation) are all rare within the BSC population. Average length of stay (ALOS) was calculated for each of the 21 weight/clinical groups. This length of stay included any readmissions or transfers. The analysis was repeated with data from 2005. We then calculated the difference in weighted ALOS between the 2003-2004 baseline and the 2005 treatment groups. Preliminary Results: The ALOS for the 2003-2004 baseline group was 24.3 days (N=2015). In the treatment group, 194 patients from 2005 1st quarter have complete follow-up. We found a reduction in ALOS of 3.5 days. These preliminary results are statistically significant with a p-value of 0.03. The program costs (vendor costs plus internal BSC costs) are substantially less then the cost savings from the reduction in NICU days. Readmission rates will be assessed when 2005 2nd quarter data is released. Limitations: Expensive NICU cases take longer to process then most hospital claims, with some cases not getting full adjudication for more the 180 days. Thus there may be further revisions to 2005 first quarter data. Data from the subsequent quarters will be available in late 2005 and early 2006.
