The cost of caring for the most expensive patients to treat can be cut through a more focused approach to providing care. But it will take a shift in medical care strategy to realize gains across the Medicare patient population.
An analysis of data from a Medicare pilot program found that a patient-centered care model applied to high-use patients returned $1.82 on every dollar spent. Mercer performed the analysis, with results published in a white paper, "Integrated Patient-Centered Care Management in the Medicare Supplement Population," available on the consulting firm's website.
Mercer used data from a three-year pilot program (2009-12) that involved Medicare Supplement patients covered by UnitedHealthcare. In part, the report said the patient-centered care model "improved health outcomes, reduced care fragmentation and lowered costs for both Medicare and patients … By providing intensive case management to patients with complex care needs, the pilot achieved a Return on Investment of $1.82 per dollar invested, 81 percent of which directly benefits Medicare."
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Such results are beginning to build a strong case for a more intensive process for treating the high-cost Medicare patients. Another pilot program, Independence At Home, authorized by Congress, is in its third year of studying what happens when homebound patients on Medicare receive treatment in their homes and have special advocates (transition teams) to reduce emergency room visits and 30-day hospital readmissions.
While final results haven't been released, early returns suggest the combination of home medical visits and advocates can substantially lower the costs of treatment for this group.
The Mercer analysis reviewed data from more than 28,000 AARP Medicare Supplement Plan beneficiaries with multiple diagnoses, all insured through UnitedHealthcare. The plan members were under the care of a multi-disciplinary team of nurses, social workers, behavioral health specialists and medical directors.
"The objective of the initiative was to gain a better understanding of the characteristics, needs and general health of AARP Medicare Supplement Plan patients, while preserving freedom of choice, enhancing care coordination and managing costs in the current fee-for-service environment. The pilot tested various care management approaches to determine how best to support the health and needs of this population," Mercer said in its report.
Among the major outcomes:
- Participants who received interventions that included a component of remote monitoring by nurses experienced a significant reduction in hospital readmissions.
- Participants who received face-to-face case management were more likely to keep up with recommended annual office visits and laboratory tests and avoid drugs not suitable for the elderly — and they demonstrated better understanding of how to better manage their conditions after participating.
- Participants in the face-to-face case management program experienced a reduction in hospital readmissions and were more compliant with office visits.
- Clinical support for depression resulted in an average reduction in overall depression symptoms.
"This pilot project shows that a patient-centered approach is a win-win situation for patients and their families, insurers and Medicare," said Charlotte Yeh, chief medical officer of AARP Services Inc. "Focusing on patients' individual health and home care needs improves outcomes, enables people to continue living independently and saves everyone money."
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Dan Cook
Dan Cook is a journalist and communications consultant based in Portland, OR. During his journalism career he has been a reporter and editor for a variety of media companies, including American Lawyer Media, BusinessWeek, Newhouse Newspapers, Knight-Ridder, Time Inc., and Reuters. He specializes in health care and insurance related coverage for BenefitsPRO.
