Chief Operating Officer at Viva Health

Dissertation Title

Does Interdisciplinary Care Team Care Management Improve Health Quality and Demonstrate Cost Effectiveness?

Dissertation Abstract

The U. S. healthcare system faces unsustainable rising healthcare costs. Health care cost as a percentage of gross domestic product is expected to rise to 19.4 percent by 2027 (Wilson, 2019). This unstainable rise in healthcare costs is creating a problem for consumers of healthcare. By 2030, the average annual healthcare spending per working household, including premium and out-of-pocket expenditures, is estimated to be 33.9 percent of median compensation (Girod et al., 2016). Also, lawmakers and policymakers face funding issues of healthcare.

A key finding of this study is that field-based interdisciplinary care team care management, with an algorithm selecting patients that are the most impactable, shows an improvement in quality as measured by a reduction in inpatient admissions and reduces healthcare cost. In this study, quality improved with a 56 percent reduction in inpatient admissions, and healthcare costs were reduced by $1,121.76 per member per month. Moreover, the healthcare cost reduction from the program generated enough savings to cover the program's cost and a return on investment of $1.9 MM, or $614.88 per member per month.

This study supports the literature that interdisciplinary care team care management programs can improve the member’s quality of health as represented in the reduction inpatient admissions (Coleman et al., 2006; McLendon et al., 2019; Litaker et al., 2003; Rothman et al., 2005; Willens et al. 2011). More importantly, this study is one of the few studies that demonstrates interdisciplinary care team care management using an algorithm to select members pays for itself. Extending care through the interdisciplinary care team, most importantly, will lead to healthier lives for members while at the same time addressing unstainable increases in healthcare.

The critical implication for stakeholders like healthcare leaders is that for interdisciplinary care team care management programs to show a return on investment, algorithms and face-to-face visits should be employed to find members most susceptible to improvement. If the algorithms and face-to-face visits are not used, then the program may find that staffing the program costs more than the savings generated by healthcare cost reduction.