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Intensive management increases outpatient care

Patients at high risk for hospitalization who were enrolled in an intensive management program received more outpatient care without an increase in costs, according to research published in Annals of Internal Medicine.

“Primary care models that offer comprehensive, accessible care to all patients may provide insufficient resources to meet the needs of patients with complex conditions who have the greatest risk for hospitalization,” Jean Yoon, PhD, MHS, from the U.S. Department of Veterans Affairs Health Economics Resource Center and Center for Innovation to Implementation, and colleagues wrote.

To determine the impact of augmenting primary care with team-based intensive management on health care utilization and costs for high-risk patients, Yoon and colleagues conducted a randomized quality improvement trial.

The researchers enrolled 2,210 primary care patients at high risk for hospitalization (mean age, 63 years; 90% men) and randomly assigned 1,105 to intensive management and 1,105 to usual care. Intensive management included care coordination with specialists, goals assessment, health coaching, medication reconciliation, mental health services, social work services and home visits with a team of health care professionals, including a physician or nurse practitioner, a nurse and psychosocial experts.

Results showed that 44% of participants in the intensive management group received intensive outpatient care, which was defined as three or more encounters in person or by telephone, and 18% received limited intervention.

The intensive management group had more of a decrease in mean inpatient costs from before randomization to after than the usual care group (–$2,164; 95% CI, –7,916 to 3,587). Due to more use of primary care, home care, telephone care and telehealth, the intensive management group had a greater increase in outpatient costs than the usual care group ($2,636; 95% CI, 524-4,748). Throughout the study period, the mean total costs for both groups were similar.

“Our finding that patients in the intensive management group did not have lower acute care or total costs implies that the promise of cost savings from such programs remains elusive,” Yoon and colleagues concluded. “However, the cost shift from inpatient to outpatient care and the overall cost neutrality of the added intensive services indicate that a potential exists to change how care is delivered... Overall, our findings and those of other studies suggest that improvements in the design of intensive management programs are not only possible but necessary for this approach to achieve its full desired benefits.” – by Alaina Tedesco

Disclosure: The authors report no relevant financial disclosures.