Objectives: The Complex Case Management (CCM) program from Blue Cross and Blue Shield of Louisiana (BCBSLA) is a healthcare quality improvement program designed to incentivize providers through valued partnerships to improve quality and reduce costs for patients with complex health conditions. The CCM program assigns professional case managers to members to help assess, plan, and facilitate personal treatment options and care. The purpose of this study was to evaluate the effectiveness of the CCM program.

Methods: BCBSLA estimated differences in healthcare utilization and expenditures for eligible members who were engaged in the CCM program after being referred, versus those referred members that never engaged in the program. Baseline differences between groups were adjusted via propensity score matching, followed by difference-in-difference analyses for each outcome of interest (healthcare utilization and expenditures).

Results: CCM members had increased primary care visits and specialty visits, but lower acute care visits, compared to non-participants. The results suggest that certain referral sources were more effective in terms of improving clinical outcomes and reducing costs. CCM members referred via inpatient hospitalization or the emergency room (ER) had fewer acute care visits (hospitalizations and ER) compared with non-participants. Savings of $160 and $233 per member per month in medical cost also were observed among members who entered the program through inpatient or ER referral sources, respectively.

Conclusions: BCBSLA’s Complex Care Management program improves outcomes for members with complex medical conditions.