Question / Intervention Goal / Objectives
Ault International Medical Management (AIMM) provides a team of nurses and doctors who work closely with patients to navigate, select, and coordinate their care. AIMM helps patients choose high-quality, cost-effective care through its programs for utilization management, care management, maternity, transplants, tele-triage, and acute care. Members are also identified through claims data mining and predictive risk modeling, so interventions can be deployed before high-intensity services are needed.
Employer clients select the level of care management they desire. The level of care management is based upon MCG and vary according to the stringency of the controls. The overall goal is to reduce their Per Employee Per Year (PEPY) cost while improving the patients’ quality of care.
The PEPY cost in the second or later year of the AIMM program was calculated, including all employees covered by the plan.
Findings / Metric/ Outcome/ Savings
The PEPY figures correlate to the level of care management selected by the client. Of the 18 employers included:
- Three applied the well managed guidelines and had PEPY lower than $3,884;
- Seven applied the moderately managed level and had PEPY higher than the well managed level, but lower than $9,142;
- Three selected the loosely managed level and had PEPY higher than the $9,142 but lower than $13,040; and
- Five had PEPY higher than $13,040.
The PEPY for 13 of the 18 employers was lower than the national average $12,612 in 2018, from a Willis Towers Watson Survey. Employer size ranged from fewer than 30 to more than 1,500.
As with all observational studies, other factors that are not measured may be influencing results. For example, certain types of employers may be attracted to the higher levels of care management.