Well designed and executed care management program cuts costs: Study

A study published today in the New England Journal of Medicine shows that a carefully designed and executed care management program cuts costs.

“This research proves that supporting patient involvement in the decision-making process through a scalable intervention can be an effective component of a better healthcare system.”

Health Dialog Services Corporation conducted a stratified, randomized study of 174,120 subjects and showed that empowering patients to participate in their treatment decisions generated considerable net savings - $6.00 per person per month. Implications are substantial for health plans and other payors with thousands or millions of lives under management.

"A Randomized Trial of a Telephone Care-Management Strategy", authored by David Wennberg, MD, MPH; Amy Marry, PhD; Lance Lang, MD; Stephen O'Malley, MSc; and George Bennett, PhD, assessed the effect of telephone-based care management on medical costs and resource utilization. Subjects were randomly assigned to either a usual-support group or enhanced-support group. After 12 months of intervention:

• Medical and pharmacy costs per person in the enhanced-support group were $7.96 lower than those in the usual-support group.
• With the cost of the intervention at less than $2.00 per person per month, a $6.00 per person per month net savings was generated.
• A 10.1% reduction in annual hospital admissions accounted for the majority of these savings.

"Care management interventions have been proposed as one component of remedying runaway healthcare costs," said David Wennberg, MD, MPH, Chief Science & Products Officer, Health Dialog. "This research proves that supporting patient involvement in the decision-making process through a scalable intervention can be an effective component of a better healthcare system."

The entirety of the study can be accessed here: www.healthdialog.com/go/RCT.

Until now there has been debate about the efficacy of care management support. Studies to date have been largely inconclusive in terms of whether programs truly save money. Unlike traditional disease management programs, the Health Dialog intervention was able to generate these results in a large scale, randomized controlled trial because of four critical differences in program design and delivery that have not appeared in previous studies of care management effectiveness:

Consumer empowerment: The Health Dialog program acts principally by empowering individuals with a wide range of conditions including but not limited to chronic conditions, to participate in medical treatment decisions with their doctors. This contrasts with other programs which focus narrowly on one or two disease-specific metrics such as closing a particular care gap.

Shared Decision Making® support: The Health Dialog program offers decision support through multimedia decision aids and coaching for key preference-sensitive surgical decisions which can drive costs, such as hip, knee and back surgeries. In this study, inpatient and outpatient surgeries were 9.8% lower in the enhanced-support group across 6 targeted preference-sensitive conditions.

Innovations in engagement: Health Dialog was able to engage almost 3x as many high potential utilizers of the healthcare system (10.4% vs. 3.7%) in the enhanced group in part because individuals were scored differently for risk, but also for receptivity to coaching.

Unwarranted Variation^TM analytics: Health Dialog has developed innovative, tested tools that incorporate research on overuse and underuse of care to identify the most impactable members. These analytic models uniquely incorporate local healthcare system factors and practice patterns, as well as patient receptivity to coaching intervention.