The results are in: population-based care management doesn’t just improve patient satisfaction – it also can significantly reduce medical costs.
It is widely known that chronic disease accounts for 75% of the total cost of healthcare in the United States. In the late 1990s, the care management industry grew out of the need to combat this problem, by increasing medication compliance, reducing gaps in care, and helping individuals become more empowered to actively manage their own health.
Care management programs have long been shown to increase medication compliance and use of other preventative services, and individuals who participate in care management programs find them extremely valuable. Yet the care management industry has always faced challenges in verifiably demonstrating the effectiveness of its programs in reducing medical costs. Several methodologies have been created to attempt to reverse-engineer a calculation of savings delivered by care management programs, but the gold standard of healthcare effectiveness measures, a randomized controlled trial, has rarely been done and none in a large population.
I’m pleased to say that this is no longer the case. A study from Health Dialog appearing in the New England Journal of Medicine today, uses a randomized controlled trial to definitively show the savings delivered by an enhanced care management program. The trial looked at 174,120 individuals over twelve months, measuring those individuals’ health outcomes and the total savings as a result of an enhanced care management program. The program included chronic condition management and patient decision support programs, and these services were delivered telephonically as well as online.
After twelve months, the average monthly medical and pharmacy costs per person in the trial group were shown to be $7.96 lower than the control group. A 10.1% reduction in annual hospital admissions accounted for the majority of the savings. With the cost of the programs at less than $2.00 per member per month, the net savings to the health plans who participated in the study came to $6.00 per member per month.
There were four unique factors in the success of this particular program. The first was a coaching approach that focused on empowering individuals to participate in medical treatment decisions across a wide range of conditions – not just chronic – with their doctors. It is important to recognize that people are not diseases (or collections of diseases). Every person possesses a unique set of strengths and faces individual barriers to a healthier life.
The second factor was Shared Decision Making – decision support through multimedia decision aids combined with coaching. Third, the program achieved a high level of engagement by utilizing unique analytic models for risk-scoring individuals, customizing outreach, and predicting receptivity to coaching. Lastly, unwarranted variation analytics allowed us to incorporate local healthcare system factors and practice patterns into our outreach strategies.
As the U.S. healthcare system continues to strain under the weight of the costs associated with care, population-based care management will play an increasingly important role in helping to manage those costs. This research proves that supporting patient involvement in the decision-making process through scalable interventions can be an effective component of a better healthcare system, now and in years to come.
David Wennberg, MD, is the Chief Science and Product Officer at Health Dialog, a care management company based in Boston, MA that serves over 20 million lives. David is also a member of the Primary Project Team of the Dartmouth Atlas Working Group at the Dartmouth Institute for Health Policy and Clinical Practice.