A recent Harvard Medical School study compared data compiled over eight years from patients enrolled in Blue Cross Blue Shield’s Alternative Quality Contract (AQC) to a control group in other states. The AQC is a population-based model that utilizes rewards and penalties based on healthcare provider performance. The study revealed that care management services have a definite positive effect on patient outcomes and the hospital’s finances. Here’s what the study demonstrated.
Improved Patient Care
The study, which included case management provided to vulnerable populations (e.g., those with chronic conditions or co-morbidities), saw improved patient wellness and reduced health insurance costs indicating high value care. Positive results also stemmed from employers starting health and wellness programs to tackle some common behaviors such as smoking, lack of exercise, and poor heating habits that contribute to serious health conditions. Also, hospitals using case managers to schedule follow-up appointments for patients prior to their discharge saw significant results. Further advancing value-based healthcare were hospitals using case managers to assist patients with their medication management and maintaining contact with the patients after discharge to monitor their health. The findings confirmed that case management used in these ways positively effects patient outcomes.
Reduced Hospital Readmissions and Extended Stays
Another finding supported by the study was that coordinated, patient-centered care provides a long-term benefit in reducing both hospital readmissions and extended stays. Additionally, hospitals reported that case management was instrumental in reducing unnecessary emergency department visits and testing for which data analysis could alternatively provide a sound treatment plan.
By the Numbers
Harvard researchers further demonstrated the value of case management in a pilot program involving an estimated 750 Medicare Advantage members with chronic illnesses. In the program, the insurance companies and Medicare emphasized care management to improve both patient health outcomes and financial incentives. The program concluded that, as a result of care management intervention, providers experienced 50% fewer hospital days for every 1,000 patients, 45% fewer hospital admissions, and 56% fewer readmissions when compared to an unmanaged Medicare population.
For healthcare providers, the evidence that care management supports value-based healthcare is clear. The important role of care managers in improving the quality of patient care and outcomes, along with hospital’s fiscal performance, cannot be overstated.