Telephone Care-Management Strategy Reduces Healthcare Costs and Hospitalizations

Patient satisfaction with treatment and their use of preventive services can be increased with utilization of telephone interventions designed to promote self-management skills and to improve communication between patients and physicians. To date, there have been few studies demonstrating the effect of telephone care-management strategies on healthcare costs. Researchers recently conducted a stratified, randomized, quality-improvement trial to evaluate the effectiveness of care-management strategies in reducing medical costs in an insured population. They reported study results in the New England Journal of Medicine [2010;363(13):1245-1255]. The researchers tested 2 care-management strategies, usual support and enhanced support, in an insured patient population. The study was conducted through a collaboration between Health Dialog Services and 2 regional health plans. The difference between the 2 strategies was the extent of outreach, with predictive models used to target a larger proportion of subjects for outreach in the enhanced-support group. Study participants (n=174,120) were randomly assigned to either a usual-support group or an enhanced-support group. Health coaches contacted participants with selected medical conditions and predicted high healthcare costs to educate them about shared decision-making, self-care, and behavioral change. Both groups received the same telephone intervention; a greater number of participants in the enhanced-support group were made eligible for coaching through the lowering of cutoff points for predicted future costs and expansion of the number of qualifying health conditions. The primary study outcomes at 1 year were total medical costs and number of hospital admissions. At baseline, the demographic characteristics of the 2 groups were similar. There were also similarities between the groups in terms of chronic health conditions, risk for preference-sensitive surgeries, medical costs, and use of hospital services. The study design called for a greater proportion of participants in the enhanced-support group to be targeted (25.8% vs 7.8% in the usual-support group) and coached (10.4 vs 3.7% in the usual-support group). Participants with selected chronic conditions (heart failure, chronic obstructive pulmonary disease, coronary artery disease, diabetes, or asthma) were given the most coaching, followed by those with preference-sensitive conditions, and those with additional high-risk conditions. During the 1-year follow-up period, costs for facility and professional services in the enhanced-support group were $8.48 lower than in the usual-support group, a 4.4% reduction in healthcare expenditures for the total population (P=.03). Pharmacy costs in the enhanced-support group were $0.52 higher than in the usual-support group. The overall reduction in healthcare costs was $7.96 per person per month (P=.05). When the cost of the intervention (<$2.00 per person per month) was included in the calculation, the net savings was $6.00 per person per month. There was a 10.1% reduction in annual hospital admissions in the enhanced-support group (P<.001), accounting for the majority of savings. The reduction in hospital admissions was due primarily to a 13.3% population-based reduction in admissions for high-variation medical conditions (P=.002) and an 11.5% reduction in admissions for preference-sensitive conditions (P=.03). There were fewer admissions in the enhanced-support group compared with the usual-support group in subjects with chronic conditions (13.7%; P=.02) and those with other high-risk conditions (11.8%; P=.04). Study limitations cited by the researchers include the inability to generalize the results to other populations and lack of data that would have enabled the researchers to analyze mortality or changes in functional status. In conclusion, the researchers said that a “targeted telephone care-management program was successful in reducing medical costs and hospitalizations in this population-based study.”