This brief fact sheet, produced by The SCAN Foundation, and based on a larger SCAN-supported report from Avalere, “Effective Management of High-Risk Medicare Populations”, provides an overview of a return on investment (ROI) analysis to identify the types of services that are cost-effective for Medicare beneficiaries whose Fee-for-Service (FFS) spending is in the top 20 percent of total Medicare spending. Six widely adopted care transition/care coordination models were selected for the ROI analysis: Care Transitions Intervention; Care Transitions Intervention (Group Visit); Geriatric Resources for Assessment and Care of Elders (GRACE); Project RED (Re-Engineered Discharge); Project BOOST and Transitional Care Model.
Key takeaways from the report include:
The ROI of implementing these five coordinated care models ranges from 32.37 % to 607.02% and the PMPM ranges from $10.05 to $343.06.
Program models that integrate care transition and long-term care management are costeffective in reducing high-cost utilizations.
Evidence-based care transition and coordination programs can result in positive ROI for MA plans looking to better manage their high-risk members.
Higher program investments are not necessarily associated with better results
Many of the interventions that the report identifies as contributing to ROI are representative of the kinds of services that many community-based organizations (CBOs) are able to provide. When CBOs are interested in partnering with a health care entity, having information on the ROI of their involvement can be critically important.
View the resource: Achieving Positive ROI via Targeted Care Coordination Programs