Research Finds Comprehensive Care Management Improves Quality, Reduces Use of Services, Saves Costs

FOR IMMEDIATE RELEASE: Tuesday, Sept. 9, 2014

Contact:
Leslie Champlin
Senior Public Relations Strategist
(800) 274-2237, Ext. 5224
lchampli@aafp.org

WASHINGTON, DC — Medicaid beneficiaries who received services from a comprehensive care management program in a patient-centered medical home dramatically cut their use of emergency rooms and hospitals and, as a result saved millions of dollars in costs, according to research by the Robert Graham Center.

The research, “Cost, Utilization, and Quality of Care: An Evaluation of Illinois’ Medicaid Primary Care Case Management Program,” reported that between 2007 and 2010, the overall Medicaid savings was $1.46 billion. It was published in the September-October issue of Annals of Family Medicine.

“The Illinois Medicaid primary care case management program was associated with significant cost and utilization reductions compared to projections, and with significant improvement of quality,” wrote author Robert Phillips, MD, Jr., Md., MSPH, vice president of research and policy at the American Board of Family Physicians, and his Robert Graham Center colleagues.

The study found an increase in virtually all quality measures: a 77 percent increase in the number of patients getting a colonoscopy, a 65 percent increase in the number of women getting a cervical cancer screening; a 52 percent increase in the number people with diabetes who received a retinal eye examination, an 87 percent increase in the number of women who received a mammogram, and a 35 percent increase in the number of patients with ischemic vessel disease getting an annual lipid profile,

For Medicaid patients enrolled in a primary care case management program called Illinois Health Connect, the savings was estimated at $237 million. For dually eligible patients enrolled in Your Healthcare Plus program and who have both Medicaid and Medicare, the savings reached an estimated $518 million.

Much of the savings results from reductions in hospitalization rates (down 18 percent for IHC patients and nearly 10 percent for YHP patients), avoidable hospitalizations (down 17 percent for YHP patients, shorter hospital stays (down 16 percent for IHC patients and 13 percent for YHP patients) and fewer hospital days, and emergency department visits rates (5 percent for IHC patients and nearly 5 percent for YHP patients).

“From 2006 to 2010, the overall Medicaid program also realized substantial reductions in hospitalizations (15.1 percent), bed-day rates (18.6 percent) and avoidable hospitalizations (19.4 percent),” the researchers wrote.

The study confirms previous research into the effect of comprehensive, coordinated care and improvements in quality and costs, according to co-author Stephen Petterson, PhD, research director at the Robert Graham Center.

“These data are consistent with findings from other comprehensive care studies,” he said. “They show the link between providing comprehensive care management and both improved quality of care and savings for the system. This information will be extremely helpful to health care policy makers as the country reforms our health care system, focuses it on meeting patients’ needs and develop policies to contain costs.”

The authors offered several conclusions, including:

Enhanced fee-for-service increased physician participation in Medicaid and improved beneficiary access.
Blended payments that include capitation and robust quality rewards can help reduce inpatient and emergency department costs and utilization.
Disease and care management programs may work best when they have close relationships with patients and providers.
It may take three or more years to reveal the full effects of insurance and practice transformation experiments.
Evaluations need to account for epidemics or other environmental factors that may inflate or deflate outcomes.
State-based experiments need embedded evaluation to avoid bad policy decisions in the absence of data.