print-icon.png

 email-icon.png

Improving Value

Better Coordinated Care for Complex Cases

Good models of coordinated care provide integrated, comprehensive and responsive services. Models should include:

  • Individuals at the center of the service plan and delivery with systems to incorporate their input and feedback
  • Services spanning medical and non-medical purposes
  • Payment incentives to achieve better health outcomes
  • Provider networks and interdisciplinary care teams
  • Effective communication systems.

Early research has demonstrated mixed savings and diverse interpretations of the term “coordinated care.” A single definition and understanding of the model is essential in appropriately understanding cost savings indicated in relevant research.

Care coordination is a model that focuses on orchestrating the various services a patient will use to best provide proactive, continuous care. This model allows for flagging inconsistent care (e.g., missed appointments) and early intervention opportunities (e.g., signs of a developing chronic condition). Evidence suggests this model may deliver higher quality care, better health outcomes and decreased care utilization.1 This strategy differs from disease management (focus on quality improvement) and case management (focus on cost savings), both of which have mixed reported outcomes demonstrating limited cost savings or quality improvements.2,3

In 2001 The Centers for Medicare & Medicaid Services (CMS) ran a 15 site pilot project evaluating the impact of coordinated care on Medicare beneficiaries with chronic conditions. The most successful programs reduced hospitalizations but realized minimal cost savings, if any. Greater success was associated with frequent face-to-face contact with patients, strong patient education, management of care setting transitions, care coordinators maintaining active in communicating with physicians and patients, and medication management. Also, to generate cost savings from these models, it is suggested to include modest fees or more significant reductions in hospital admissions.4

The care coordination model should be particularly beneficial to individuals with Multiple Chronic Conditions (MCCs) and dual eligibles, or beneficiaries enrolled in Medicare and Medicaid. These patients require the most care, spend the most money and juggle multiple providers, medications and payers (e.g., Medicaid and Medicare).5 Currently, there are several initiatives attempting to address this niche group, including Medicare Advantage Special Needs Plans, state alterations to Medicaid financing structures to accommodate these care models, Vermont’s Blueprint for Health public-private initiative and private initiatives for care coordination system for people with disabilities.

Notes

1. JEN Associates, Inc. MassHealth Senior Care Options program evaluation: Pre-SCO enrollment period CY2004 and post-SCO enrollment period CY2005 nursing home entry rate and frailty level comparisons. (June 2008)

2. Ayanian, J.Z., et al., The elusive quest for quality and cost savings in the Medicare program. Journal of American Medicine, Vol. 301, No. 6 (February 2009)

3. Esposito, D., et al., “Impacts of a disease management program for dually eligible beneficiaries,” Healthcare Financing Review, Vol. 30, No. 1 (2008).

4. Burwell, Sylvia M., Fifth Report to Congress on the Evaluation of the Medicare Coordinated Care Demonstration: Findings over 10 Years, Department of HEalth and Human Services (November 2014).

5. Hackbarth, G.M. Reforming the healthcare delivery system. Testimony of the Medicare Payment Advisory Commission Chairman before the Committee on Energy and Commerce, U.S. House of Representatives (2009, March 10).