A targeted telephone care-management program can help cut medical costs and hospitalizations if offered to an expanded group of consumers, according to a study published yesterday in the New England Journal of Medicine. The process involves trained nurses who make telephone calls to patients at high risk of serious health problems and offer information on the risks and benefits of different therapeutic options.
Care management is typically confined to people who find it hard to manage chronic conditions or those facing big treatment decisions, such as surgery or medical management for lower back pain, the Wall Street Journal reports.
In contrast, the NEJM study found that expanding the target consumer pool for care management to include chaotic users of the healthcare system--who don't necessarily have a chronic illness, but turn to the ER for routine care--can help cut healthcare tabs. The expanded group faced fewer barriers to entry: cutoff points based on projected healthcare costs were lower and more health conditions were on the list.
Call center staff also used electronic medical records to identify patients considering prostate, hip, knee, back or uterine surgery, and coronary revascularization, the Fiscal Times reports. Staff sent consumers web links, video and print materials before the operation, comparing the risks and benefits of surgery with options like watchful waiting, bedrest, anti-inflammatory drugs and diet and exercise changes.
Average monthly medical and pharmacy costs were 3.6 percent lower for patients in the expanded support group, compared with the traditional more restricted group. Most of the savings could come from a 10.1 percent cut in annual hospital admissions.
If done well, with a total population approach, you really can improve quality and reduce costs and increase patient satisfaction, David Wennberg, chief science officer for Health Dialog Services and lead author of the study, told the Times. The company sells the intervention service through 20 different health plans that cover 20 million people.
To learn more:
- read the New England Journal of Medicine abstract
- read the Fiscal Times article
- here's the Wall Street Journal article
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