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Guided care model holds promise

A new study has found that guided care of patients with multiple chronic conditions is ambiguous in terms of cost, but still holds value to people from various sectors of the healthcare industry.

“The whole field has not been able to demonstrate cost savings,” said Chad Boult, MD, of Johns Hopkins Bloomberg School of Public Health, one of the authors of the study. “We can’t really claim with statistical certainty that this had cost savings.”

“The Effect of Guided Care Teams on the Use of Health Services,” published in March in the Archives of Internal Medicine, describes the results of a cluster-randomized controlled trial of 850 older patients done by Boult and his colleagues.

The study showed a reduction in the use of home healthcare and fewer skilled nursing facility days and emergency department visits, but not much of an effect was found on the short-term use of other health services.

It also suggested that guided care improves the quality of care of these patients, reduces the stress of family caregivers and increases physician satisfaction with the care given to patients.

“These are not discouraging results,” Boult said. “It’s all a process. Our research is built on other research and others will build on ours.”

“We can’t give up on this,” he added. The next step, he said, is “How can we take what was positive and make it even better?”

Debbie Peikes, senior researcher at Princeton, N.J.-based Mathematica Policy Research, agrees with Boult that the model is too promising to give up on. “We need to redouble efforts to understand what will reduce costs among the small share of people that tend to drive costs,” she said.

As people live longer, the likelihood that they will have multiple illnesses means costs are going to increase because they will need more care, said Tom Loker, chief operating officer of healthcare management company Ramsell Holding Corp.

“I think it’s (the model)not only valuable, it’s required,” he said. He cites just one example of how a guided care model reduces costs: duplication elimination.

“Reducing duplication of care is required if we’re going to have an effective healthcare system,” he said.

Peikes, Boult and others think some strategies to make the guided care model more cost-effective include providing financial incentives to those involved in the guided care team and a re-assessment of the patients who would most benefit from such a care model.

Peikes also thinks people need to modify their expectations.

“It would be reasonable to expect programs to improve quality and be cost neutral (by reducing costs enough to offset the increased costs of care management), or (at best) to generate modest savings,” she said.


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