Advocates for Evidence-Based Health Policy Speakers
The Myth of Care Coordination, Quality, and Cost Savings
An analysis of 15 Medicare Coordinated Care Demonstration projects, covering 18,402 Medicare patients from across the nation, demonstrated limited to no evidence of the benefit of care coordination towards the goal of improving quality or cost-effectiveness of care. Patients in the 15 programs (selection and exclusions determined independently by each site) were randomly assigned to either customary care or the “treatment” (typically patient education, communication, and monitoring by nurses). The fifteen different projects included private disease management companies, academic medical centers, community hospitals, and other care models. Large proportions of patients had coronary artery disease (>40%), congestive heart failure (>40%), diabetes (>20%), or other chronic conditions.
Of the 15 programs studied, only Georgetown University (24% fewer admissions; p=0.07) and Mercy Medical Center (17% fewer admissions; p=0.02) showed a statistically significant reductions in annual hospitalizations in their care coordination group. Eight of the remaining programs were adequately powered (beta=0.80) to detect a 20% difference in annual hospital admission rates yet failed to do so.
This demonstration project clearly showed that no care coordination program reduced Medicare expenditures. In fact, nine of the thirteen programs had significantly greater costs than their control groups (ranging from 8 to 40 percent more expenditures). Two-thirds of the demonstration projects were adequately powered (beta=0.80) to detect a reduction in Medicare expenditures of 20% but failed to do so.
Commentary:
The present study provides convincing evidence that disease management programs for Medicare beneficiaries is neither cost-effective nor productive of reliable clinical outcomes. While care coordination may be a goal that policy-makers might strive toward, it is no panacea for getting higher quality health care for less money. Although, physicians and beneficiaries tended to enjoy the care coordination programs, these “feel good” outcomes cannot overrule the lack of objective benefit for other, measurable, “hard” outcomes.
by
Cedric K. Dark, MD, MPH