Care management is relatively costly. Offering care management to patients who are not expected to be high utilizers of hospital, specialty and emergency department care would not reduce costs. Similarly, care management for patients too sick to benefit is ineffective.
Does care management improve quality and reduce costs?
Patients who are experiencing poor quality outcomes often require more hospitalizations and emergency department visits. For this reason, utilization of high-cost services can be viewed as one marker of inadequate quality of care.
There is strong research evidence that care management improves quality, but the effect on cost reduction is less consistent. Hospital-to-home care management programs have had the most success in reducing costs. Care management in primary care improves quality, but research indicates it may take time to see results.
Commercial disease management vendors have provided data demonstrating success, but methodological issues call into question these findings. The evidence demonstrating quality improvement is stronger than the evidence on cost reduction.
Care management within integrated multispecialty groups improves quality, but does not consistently reduce costs. The most effective care management programs are those targeting patients discharged from hospitals. Studies have found that care management programs targeting the hospital-to-home transition have reduced hospital readmissions and lowered costs.
What are the keys to successful care management?
- In-person encounters: Person-to-person encounters, including home visits, are necessary features of effective care management. Care management relying solely on telephone encounters has not shown success.
- Training and personnel: Programs with specially trained care managers who have a relatively low workload are most successful. Most care managers are registered nurses (RNs) who work as part of a multidisciplinary team.
- Physician involvement: Placing care managers with physicians in primary care practices may help facilitate physician involvement.
- Informal caregivers: Patients with complex health care needs, particularly those with physical or cognitive functional decline, often need the assistance of informal caregivers to actively participate in care management.
- Coaching: Coaching involves teaching patients and their caregivers how to recognize early warning signs of worsening disease.
