The Gerontologist, Vol 37, Issue 6 777-784, Copyright © 1997 by The Gerontological Society of America
The effect of accurate patient screening on the cost-effectiveness of case management programs
DB Mukamel, CC Chou, JG Zimmer and BM Rothenberg
Department of Community & Preventive Medicine, University of Rochester School of Medicine & Dentistry, NY 14642, USA. [email protected]
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.