Study Shows Virtual Network Saves Millions in Medicaid

  • Published On  Dec 1, 2017


Study Shows Virtual Network Saves Millions in Medicaid

Integrated delivery system, real-time alerts break new ground

CHICAGO – A comparison of the utilization and cost outcomes for Medicaid patients whose care is delivered and coordinated through Medical Home Network’s integrated delivery system showed an $11 million cost reduction over two years, according to a paper published on the website of the journal Population Health Management.

As state Medicaid programs face tighter budgets yet have increased flexibility in designing care coordination models, the study’s author suggests the findings could help insurers, providers and administrators design the most effective care models.

“Most health insurers provide care management from a centralized office, with care coordinators reaching out to patients by phone. But those coordinators often are not familiar with either the community in which the patient lives or the unique resources available” said Dr. Art Jones, chief medical officer, Medical Home Network.

Medical Home Network (MHN) is an integrated network of providers from three hospitals and nine federally qualified health centers with more than 80 medical homes on Chicago’s south and southwest sides that coordinate the care of Medicaid beneficiaries. A secure web-based portal, MHNConnect, tracks each patient’s hospital and emergency department activity in real time, providing primary care physicians and care coordinators instant alerts and patient data needed to prioritize tasks and coordinate care among the several hospitals and clinics Medicaid patients typically visit.

“The results suggest having a practice-based network of primary care providers connected by web technology allows providers to develop stronger relationships and engagement with enrollees,” said Tricia Johnson, PhD, Associate Chairperson, Department of Health Systems Management at Rush University’s College of Health Sciences and lead author of the study.

The purpose of the study was to evaluate the impact of an integrated delivery system where care coordination occurs at the practice level, with the more prevalent care coordination program in which health insurers coordinate care telephonically from a remote location. The retrospective analysis compared utilization and cost data over two years for the approximately 170,000 Medicaid enrollees cared for through MHN.

“By sharing care models, financial incentives and data, participating providers are better positioned to coordinate care for their patients by developing face-to face relationships and being more familiar with community resources. The integrated delivery system allows for those human connections, which really make a difference,” Johnson added.

Among the key findings were:

• The proportion of MHN enrollees who completed a primary care visit within 7 days after an emergency room visit substantively increased in Performance Year 2, while the proportion of non-MHN enrollees who completed a follow-up primary care visit in the same window of time decreased.

• After accounting for the MHN care coordination fees paid to providers, net cost savings were $6.94 per-member per month (PMPM) the first year, and $10.69 PMPM in Performance Year 2, for a net risk-adjusted cost savings of $11.0 million over two years

• Hospital length of stay decreased by 1.1% for the MHN group while increasing by 19.1% for the non-MHN comparison group.

“People who lack a primary care medical home often seek care from multiple health care providers, making it extremely difficult for each of those providers to focus on their long-term care. But the web-based MHNConnect tool alerted primary care teams in real time when a patient visited or was discharged from a participating hospital or clinic, providing instantaneous, actionable data that helped providers prioritize tasks,” said Cheryl Lulias, president and executive director, Medical Home Network.

“Knowing when a patient visits an ED or is going to be discharged from the hospital allows physicians and care coordinators to schedule follow up care that day. For patients with complex illnesses, that can be the difference between treating the cause of their disease, not just the symptoms,” said Johnson.


The title of the study published in Population Health Management is “Practice Innovation, Health Care Utilization and Costs in a Network of Federally Qualified Health Centers and Hospitals for Medicaid Enrollees” authored by Tricia J. Johnson, PhD, Art Jones, MD, Cheryl Lulias, MPA, and Anthony Perry, MD.

About Medical Home Network

Medical Home Network is transforming health care delivery for Medicaid patients by fostering collaboration and innovation. Our proven model of care unites communities of providers and patients around a common goal: To redesign health care delivery and transform the way care is managed when doctors interact with patients, resulting in improved patient outcomes and lower costs.