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San Francisco, CA - Comprehensive patient care management techniques that include patient education, provider and care coordination and professional support can sharply reduce utilization, such as hospital days and emergency room visits, and overall costs over typical care management programs. A study of Blue Shield of California HMO members, published in The American Journal of Managed Care last year, qualified actual cost reductions for patients with illnesses such as late state cancers or degenerative neurological conditions who participated in this type of expanded care management program.

More comprehensive than usual care management interventions, patient-centered management (PCM) assigns highly trained nurses to provide extensive patient education and care coordination as well as pain and end-of-life management. PCM helps patients select services, consider different treatment options and avoid unnecessary hospitalizations and emergency room visits, in essence changing some patient behaviors and environments that impair their care or yield unnecessary healthcare expense.

The study results were very positive, according to Dr. Sweeney, director of the Data Privacy Lab at Carnegie Mellon and the studys lead author with Andrew Halpert, MD, Blue Shield of California, and Joan Waranoff, MS, MBA, Blue Shield of California Patients who received PCM had 38 percent fewer hospitalizations, a 22 percent increase in home care and suffered fewer treatment complications, such as nausea, anemia and dehydration, than patients who received usual case management. Many cancer patients in the PCM group opted against further chemotherapy or radiation treatment (42 percent less chemotherapy than the patients in the group receiving usual care). The PCM group also had 62 percent more days in hospice care than the usual care group. Moreover, participant satisfaction scores were highly favorable.

Overall, the study concluded that the PCM effectively reduced overall costs by 26 percent. The savings were realized in patients having fewer costly hospital days and emergency room visits, with care shifting to less costly home care and hospice settings when appropriate. The average combined utilization cost of the PCM cohort was $49,742 per patient for the 18-month study duration, compared with $68,341 in the UCM cohort, which average savings of about $18,599 per patient. After accounting for the additional cost of the program, the return on investment was 2:1.

SOURCE: patient-centered management