Patient-Centered Care Management: Enhanced Quality of Life at Lower Cost

Beginning in February 2003, Blue Shield offered an innovative “patient-centered care management” program to CalPERS’ beneficiaries who were coping with advanced illness often involving end of life issues.

The goal of the program was to reduce unnecessary hospitalizations and emergency room visits through an intensive, patient-centered program of education, support and service coordination. Each of the 358 patients assigned to the demonstration program received an initial telephone call. Upon their consent, patients were then assigned to a “complex care” team and received an initial home visit to establish specific care goals. Goals might address existing weaknesses in patient knowledge of his or her disease, treatment plan, terminal care planning, pain and symptom management, and family and living environment. On average, the care team spent 10 hours per patient per month reviewing patient status, developing strategies to accomplish care goals, and engaging in patient education, advocacy and support.

To track the program’s effectiveness, Blue Shield established a control group of similarly ill patients in more traditional care management programs. These programs typically contract with multiple vendors each servicing one condition in a context where the patients being managed have more than one disease. Such an approach often results in uncoordinated care, with potentially adverse patient and cost effects.

Blue Shield’s program evaluation, the results of which were published in the academic and peer-reviewed American Journal of Managed Care, showed that patients treated under its demonstration program:

• Experienced significant reductions in nausea (44%), anemia (33%) and dehydration (17%);

• Required 38% fewer hospital admissions;

• Saw a 36% reduction in total hospital days;

• Required 30% fewer emergency room visits;

• Reported a 92% satisfaction rate;

• All while dramatically increasing home care by 22%.

These and other improvements reduced the cost of care to these patients by 26 percent, demonstrating that comprehensive, patient-centered care management can sharply reduce the utilization and cost of patient care for those with life limiting illness.

Read the full report in The American Journal of Managed Care.