Cost-benefit associated with implementing a five-tier care management program

Jamaica Hospital, part of MediSys Health Network, is engaged in a shared savings program in which providers share the savings generated by managing care appropriately, as determined by pre-set quality benchmarks. Jamaica Hospital sought to evaluate the cost-benefits of implementing interventions to reduce unnecessary hospital and emergency department utilization. Jamaica Hospital asked the Capstone team to assess cost-effectiveness for the different levels of intervention and estimate a break-even quantity for each intervention’s implementation. The team conducted a literature review to examine utilization interventions with patient populations similar to that of Jamaica Hospital. The team also identified trends in utilization, acuity, and demographics and recommended other possible interventions using that analysis. Lastly, the team built cost-benefit and break-even models to demonstrate the cost-benefits associated with implementing each proposed level of intervention.