Modest improvement in quality of care, but no reduction in costs of care or acute care utilization
THURSDAY, Nov. 3 (HealthDay News) -- Commercial disease-management companies using nurse-based call centers modestly improve quality-of-care measures in Medicare fee-for-service programs with no evident reduction in costs of care or acute care utilization, according to a study published in the Nov. 3 issue of the New England Journal of Medicine.
Nancy McCall, Sc.D., from RTI International in Washington D.C., and Jerry Cromwell, Ph.D.. from RTI International in Waltham, Mass., assessed whether eight commercial disease-management models that used nurse-based call centers could achieve meaningful savings for the Medicare fee-for-service program while improving quality-of-care measures for beneficiaries, and reducing acute care utilization. In the Medicare Health Support Pilot Program, 242,417 patients with heart failure, diabetes, or both were randomly assigned to intervention (163,107 individuals) or usual care (79,310 controls). A difference-indifferences method was used to compare the effects on clinical care quality, acute care utilization, and Medicare expenditures for beneficiaries.
The investigators found that the eight commercial disease-management programs showed no reductions in emergency room visits or hospital admissions versus usual care. Out of 40 comparisons made in the process-of-care measures, only 14 showed significant improvements. These modest improvements were achieved at a considerable cost to the Medicare program due to the fees paid to the disease-management companies ($400 million), with no evident savings in Medicare expenditures.
"It is unlikely that simply managing the care of elderly patients through telephone contact or an occasional visit will achieve the level of savings that Congress had hoped for when it mandated the Medicare Health Support Pilot Program," the authors write.
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