Acute‐Care Utilization and Cost Offsets Associated With Language‐Concordant, Pharmacist‐Integrated Care Management Among High‐Need, High‐Cost Adults

OBJECTIVE: To estimate utilization and economic effects of a language-concordant, pharmacist-integrated care-management program and examine equity by language and insurance. STUDY SETTING AND DESIGN: We conducted a retrospective cohort study emulating a target trial across four Phoenix safety-net clinics (March 2022-September 2023) using inverse probability weighting and doubly robust Poisson difference-in-differences. DATA SOURCES AND ANALYTIC SAMPLE: We linked electronic health records, payer claims, health information exchange admission-discharge-transfer alerts, and pharmacist logs for 526 high-need, high-cost adults. Enrollees (n = 263) were matched 1:1 to otherwise eligible usual-care comparators (n = 263) from the same clinics and calendar period. PRINCIPAL FINDINGS: Within 60 days, hospital admissions (average marginal effect [AME], -0.44; 95% confidence interval [CI], -0.60 to -0.28; incidence-rate ratio [IRR], 0.50 [0.29-0.86]) and emergency department visits (AME, -0.16; 95% CI, -0.27 to -0.05; IRR, 0.47 [0.28-0.77]) were lower. Using standardized 2024 national unit costs and a $470 program cost, estimated net savings were $6421 per enrollee (return on investment [ROI], 13.66:1). Spanish-preferring subgroup estimates were directionally similar, and formal interaction tests were not statistically significant. CONCLUSIONS: In safety-net clinics, this language-concordant, pharmacist-integrated multicomponent program was associated with lower short-term hospital use and substantial near-term standardized cost offsets.