High-cost/high-need (HCHN) adults often present significant challenges to healthcare systems. Recognizing the need for more effective patient-centered care, Kaiser Permanente Mid-Atlantic States (KPMAS) introduced a Complex Care Program (CCP). This innovative program is designed around dedicated physician and nurse teams, each managing a small panel of patients. These teams coordinate both clinical and social services, aiming to provide comprehensive support for individuals with complex health needs.
A recent study evaluated the effectiveness of the Kaiser Complex Care Program, focusing on its impact on patient survival and hospital admissions. The study employed a retrospective cohort design, comparing patients enrolled in the CCP with a matched control group of eligible individuals who did not participate. Conducted at KPMAS during 2017-2018, the research involved 929 CCP patients and 929 matched controls.
The Kaiser Permanente Complex Care Program teams consist of a physician and nurse working collaboratively to manage care across various settings, including specialty and tertiary care, as well as community services. Each team is responsible for a panel of 200 patients who have advanced clinical conditions and a history of recent hospitalizations.
The study’s primary outcomes were time to death and time to first hospital admission within 180 days of program enrollment or eligibility. The results indicated a significant benefit in terms of survival for patients in the Kaiser Complex Care Program. CCP patients experienced a prolonged time to death compared to the control group, with a hazard ratio of 0.577 (95% CI: 0.474, 0.704). Notably, among those who passed away, CCP participants had a longer median survival time (69.5 days vs. 53.0 days, p=0.03). However, the study found that the Kaiser Complex Care Program did not significantly alter the time to hospital admission (HR: 1.081, 95% CI: 0.930, 1.258). This finding remained consistent even when accounting for the competing risk of death.
While the study acknowledges limitations such as its non-randomized design, single healthcare system setting, and specific patient eligibility criteria, the conclusion is compelling. The Kaiser Permanente Complex Care Program is associated with a substantial reduction in short-term mortality risk for eligible patients who chose to participate. This highlights the potential of specialized, patient-centered programs like the Kaiser Complex Care Program to improve outcomes for vulnerable, high-need populations.
