A guided care approach helps curb health care costs of elderly patients with chronic conditions
Research Activities, April 2010, No. 356
Care for the elderly with chronic health conditions can be very expensive. One way to help provide high-quality, cost-effective care to these individuals is by employing an approach known as guided care (GC). This care is delivered by a team consisting of a practice-based, specially trained, GC nurse who works with two to three physicians and office staff. The goal is to offer eight important clinical services that are needed by 50 to 60 percent of the highest-risk older patients in a practice. This innovative approach to care improves health, reduces care use, and nets savings in health care costs, reveals a new study.
The researchers implemented GC in eight community-based primary care practices located in urban and suburban areas. The study involved 14 primary care teams, 49 physicians, and 904 elderly patients with chronic illnesses insured by Medicare or managed care plans. The researchers reviewed health insurance claims to compare the services used by patients receiving GC with services used by those receiving usual care during a period of 8 months. GC patients used fewer hospital, skilled nursing facility, emergency, and home health care services compared with their usual care counterparts. However, they did tend to use slightly more specialist care, durable medical equipment, tests, and treatments.
The researchers looked at the financial impact GC had on health care costs and savings in a subset of 55 high-risk patients during a 1-year period. GC produced a net savings of $75,000. Two-thirds of this amount was the result of reduced hospital utilization. According to the researchers, these cost savings are enough to offset the expense of providing GC and the slight increase in use of specialist care. The study was supported in part by the Agency for Healthcare Research and Quality (HS14580).
See "Guided care and the cost of complex healthcare: A preliminary report," by Bruce Leff, M.D., Lisa Reider, M.H.S., Kevin D. Frick, Ph.D., and others, in The American Journal of Managed Care 15(8), pp. 555-559, 2009.