Case study: Mass General works to lower elder care costs

Since 2006, Boston's Massachusetts General Hospital has been engaged in efforts to cut costs by minimizing the number of hospital stays and emergency department visits needed by frail elderly patients. This is the kind of project, economists say, that will be necessary for pending health reform initiatives to be financially successful.

Ideally, the plan will save Medicare millions of dollars over time, and reduce hospitalizations for several thousand elderly patients by 15 to 20 percent. CMS is so optimistic about this that it has extended Mass General's pilot until August 2012.

But getting there is extremely tricky. To care for this population, the hospital has had to invest heavily in added primary care services to assist these patients with their complex medical needs. It relies on having nurses within primary care practices being in nearly constant contact with patients, who help to arrange even non-medical services. It also uses an electronic medical record to help coordinate care. So far, the program has managed to cover its costs and improve patient care, but savings have been elusive.

Dr. Eric Weil, a primary care physician and medical director of the program, believes that the key to success in programs like these is placing the nurses in the primary care doctors' offices. Having a care manager calling the elderly from a central site, without having a relationship with their doctors, isn't as persuasive as calls coming their doctor's staff, he argues.

Dr. Weil may be right about how to improve the quality of patients' lives and health. The question is, will this, or any model, actually save money?

To learn more about the Mass General program:
- read this item from The Boston Globe

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