title: The effect of accurate patient screening on the cost-effectiveness of case management programs.
abstract: Case management programs are expensive and therefore require careful screening of enrollees to ensure cost-effectiveness. Screening tools, however, are imperfect, with positive predictive values usually below 50%. This article examines the relationship between the accuracy of the screening tools and the cost-effectiveness of case management. Using data from a Medicare health maintenance organization (HMO), we develop an optimized 5-question screening tool. We then simulate the use of this screening tool and its impact on the cost-effectiveness of several hypothetical case management programs. The article demonstrates that even screening tools with only 20-30% positive predictive value could turn a case management program into a cost-effective program.
authors.affiliation: Department of Community & Preventive Medicine, University of Rochester School of Medicine & Dentistry, NY 14642, USA. mukamel@prevmed.rochester.edu
authors.forename: D B
authors.initials: DB
authors.lastname: Mukamel
authors.forename: C C
authors.initials: CC
authors.lastname: Chou
authors.forename: J G
authors.initials: JG
authors.lastname: Zimmer
authors.forename: B M
authors.initials: BM
authors.lastname: Rothenberg
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D003362:Cost-Benefit Analysis; D003365:Costs and Cost Analysis; D005260:Female; D006279:Health Maintenance Organizations / Q000191:economics; D006801:Humans; D016014:Linear Models; D008297:Male; D008329:Managed Care Programs / Q000191:economics*; D006278:Medicare; D018579:Patient Selection; D011237:Predictive Value of Tests; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014481:United States