As providers heatedly debate whether providing intense patient "support" saves healthcare dollars, a study of 174,120 patients concludes that it does—by about $6 per person per month.
The report suggests that two extra efforts by health coaches to make telephone contact with higher risk patients resulted in a 3.6% reduction in costs after one-year, largely due to reduced costs of hospital admission or readmission, which were 10% less. The study was conducted by David Wennberg, MD, of Health Dialog Services Corporation and colleagues, and was published in last week's New England Journal of Medicine.
"This is the largest study done of this type," Wennberg says. He adds that interventions included helping patients navigate the healthcare system as well as providing decision support. For example, decision support includes the coach helping the patient understand the pros and cons of having back surgery for sciatica, which carries risks that may be greater than managing the pain with medications, comes with a greater time to healing and may require repeat procedures. "The goal is to have shared decision making...with a fully informed patient."
The researchers also initiated phone calls to larger percentages of patients with chronic and other high-risk conditions that put them at higher risk of being hospitalized or using a high number of expensive healthcare services.
The participants, who had similar medical costs and resource utilization at the start of the study, were divided into two groups. The usual support group received three outreach attempt phone calls from healthcare coaches who teach self-care at many levels, and make sure patients understood hospital discharge instructions and adhere to medication regimens. The enhanced support group received up to five outreach attempts, if the subjects had not been contacted with the first three.
The coaches included registered nurses, dieticians, respiratory therapists, and pharmacists.
The study participants included those who were at risk for hip, knee surgeries, prostatectomies, cardiac revascularization procedures and lumbar procedures. Patients classified as being in the top 40th percentile of high healthcare utilization, those with conditions such as heart disease, those at increased risk for surgical intervention and those with chronic conditions such as congestive heart failure or diabetes were included for the enhanced support. "