OBJECTIVES: The admission-discharge-transfer (ADT) system is a key source for member referrals to the Population Health intervention program at Blue Cross and Blue Shield of Louisiana (BCBSLA). It is triggered by an episodic event such as an emergency department visit or hospitalization. The system notifies BCBSLA’s Care Management team in near real time so they may act promptly. Their actions (such as health coaching, personalized disease self-management skills for members to adhere to recommended treatment plans) aim to improve quality of care and reduce health care costs. The purpose of this study is to evaluate the effect of timely referrals for Care Management interventions.

METHODS: The periods of time of Event-to-Referral and Referral-to-Intervention were assessed among members with an episodic event who were referred by a timely ADT referral or a claim- and utilization-based review and referral (control group). Health care utilization and costs were investigated between referrals from the ADT system and control group using propensity score matching with indexed timeline and difference-in-difference analysis.

RESULTS: Members referred via the ADT system experienced a significantly shorter time Event-to-Referral than the control group [mean 3.3 (median 1) days vs. 86.1 (median 70) days, p<0.0001]. The engagement rate was 4.7 times higher for those in the ADT group than control group (38% vs. 8%). There were no significant differences in the duration of Referral-to-Intervention across the two cohorts. Difference-in-difference analysis indicated Care Management intervention through ADT referral reduced adverse events, specifically avoidable hospitalization. It directionally improved the 30-day readmission rate and the 7-day follow-up visit of hospital discharge rate, and reduced total cost of care, although not statistically significant.

CONCLUSIONS: BCBSLA’s member referrals prompted via the near real time ADT system shortened the time of Event-to-Referral and decreased avoidable hospitalizations as a result of an increased Care Management engagement rate.