The Quality Quandary: When Less Is More and More Is Less

In a diabetes study released by the National Minority Quality Forum, Medicare beneficiaries with the condition who consumed the least of their Medicare benefits and services ended up not saving money. Instead, they cost Medicare more money because they went to the emergency room more often and required more hospitalizations.

The study divided Medicare beneficiaries into five groups—crisis consumers, heavy consumers, moderate consumers, light consumers and low consumers—based on how much Medicare reimbursed for services in any year. The two most costly clusters were crisis consumers and heavy consumers, representing about 11% of Medicare beneficiaries—but 65% of all costs.

But these cluster groups could vary each year—particularly beneficiaries who are low consumers one year. They could be catapulted into the heavy consumers group the next year—triggered by a critical and costly health event.

"If we can identify these patients, who are under managing their chronic condition putting them at high risk for disease complications, we can intervene to help these individuals manage their disease more effectively, and, ultimately, reduce overall healthcare costs," says Gary Puckrein, PhD, a founding partner of the Diabetes Care Project and President and CEO of the National Minority Quality Forum, who spoke at a telebriefing where the study was released.

"As a practicing physician, we really need a paradigm shift—from a population-based approach to treating diabetes to developing a more personalized management and strategy," says Kenyatta Lee, MD, an assistant professor of community health and family medicine at the University of Florida.

So do these studies provide a lesson in comparing treatment and costs? Well, maybe more research is needed, Chen says. Possibly more efforts, such as comparative effectiveness research—or as it's referred to as "patient-centered research" in the latest federal budget—could lay a foundation for some better answers on how much to spend—less or more—for quality care and get the best outcomes.