Telephone Care-Management Program Reduces Healthcare Costs

Emma Hitt, PhD

September 22, 2010

September 22, 2010 — A targeted telephone care-management program reduced medical costs and hospitalizations, according to the findings of a population-based study.

David E. Wennberg, MD, MPH, from Health Dialog Services, in Portland, Maine, and colleagues reported their findings in the September 23 issue of the New England Journal of Medicine.

According to the researchers, a strategy for reducing medical expenditures is to provide care management, including decision-making support. "Such interventions promote self-management skills and improve patient–physician communication, with the expectation that patients who are more engaged in their health care will become better consumers of health care services, thus leading to better outcomes at lower costs," they write and go on to explain that, "Although the promise of such strategies has been well communicated, efforts to quantify the potential cost savings have been elusive."

Dr. Wennberg and colleagues conducted a large, randomized, quality-improvement trial testing 2 care-management strategies in 174,120 patients.

Participants were randomly assigned to receive either usual support or enhanced support. The same telephone intervention was delivered to the 2 groups, but the enhanced support group received up to 5 outreach attempts compared with 3 in the usual support group. In addition, more participants in the enhanced support group than in the usual support group received outreach through interactive voice-response calls or calls from a health coach.

The coaching team consisted of registered nurses, licensed vocational nurses, dietitians, respiratory therapists, and pharmacists. Coaches ensured that patients would adhere to treatment and motivate patients to make behavioral changes such as dietary modifications. The cost of the intervention was less than $2.00 per person per month.

After 1 year, 10.4% of the enhanced support group received the telephone intervention compared with 3.7% of the usual support group. The average monthly medical and pharmacy costs per person in the enhanced support group were 3.6% lower than those in the usual support group ($213.82 vs $221.78; P = .05). In addition, annual hospital admissions were reduced by 10.1% (P < .001), which accounted for most of the savings.

"Care support has been proposed as one component of the remedy for runaway health care costs," Dr. Wennberg and colleagues note. "This study shows that an analytically driven, targeted, population-based program can decrease hospitalizations and surgical procedures and thereby reduce total medical costs for the population as a whole," they conclude.

The study was supported by Health Dialog Services. All of the authors are employees of Health Dialog Services. Two of the authors (Dr. Wennberg and Dr. Bennett) report that they formerly owned stock options for Health Dialog Services, but all options have been exercised.

N Engl J Med. 2010;363:1245-1255.


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