Patient Power Matters
The study is the largest randomized trial ever published in care management — with 175,000 patients tracked for a year:
Health coaches contacted [by telephone] subjects with selected medical conditions and predicted high health care costs to instruct them about shared decision making, self-care, and behavioral change.
The results:
- A 10% reduction in hospitalizations.
- $7.96 per member per month medical and pharmacy savings.
- The cost of the program was less than $2.00 per patient.
These types of research projects are interesting. But most suffer the problem that you have to treat entire populations to better-manage the medical conditions of the few who benefit and the aggregate costs exceed the benefit. The Holy Grail of disease management is to figure out how to identify those who will benefit and not over-treat those who won’t benefit. Telemedicine holds some promise as a means to monitor and manage complex conditions.
According to the description at ClinicalTrials.gov, the collaborators were HealthNet and Highmark Blue Cross Blue Shield, i.e. private insurers.
This result will feed into the mania for Accountable Care Organizations (ACOs) and Patient-Centered Medical Homes (PCMH) that ObamaCare will subsidize. Unfortunately, the results will be very different, because the care manager will not be focused on getting better health results for fewer dollars, but maximizing federal subsidies.
Ten years or so from now, we’ll be reading stories of “telephone mills” where so-called care managers robo-call patients, have short conversations, check boxes on a list, and send a report to the government to get reimbursed.
Agreed, Mr. Graham!
OK, I’m convinced. Telephones work.
T his smacks of cost effectiveness research. Must be bad.
Steve