Results among highly varied client populations have shown ROI results in the 10:1 to 16:1 range. Among larger groups (>100,000 members), ROI has reached 20:1 year over year. These results come from more-appropriate utilization of care resources, lower claim counts, reduced ER visits, and reduced duplicative and unnecessary testing. Appropriate care choices also push down hospital recidivism rates, and MedExpert clearly reduces rates of unnecessary elective surgery.
E.R. USE
SPEND
REOPERATIONS
Among a group of “super-utilizers” in a Medicaid population, MedExpert’s interventions have significantly reduced opioid use, as this chart shows:
ABOVE: A MedExpert group consisting of the same 5,107 members commenced MedExpert care coordination and care management services in January 2015.
The 2014 year identifies opioid purchases prior to commencement of MedExpert services.
NOTE: Results for 2017 subject to claim lag. Last claim load shown occurred in October 2017. Data reported by incurred date.
[1] Claims incurred through February 28, 2014 and paid through April 5, 2015. No completion factors applied. Measurement period compared difference between May 2013 – Feb 2014 compared to pilot period of May 2014 to Feb 2015. Total population of markets in program: 144,456 Medicare beneficiaries.