Another Approach to Managing Chronic Disease

A very large proportion of America’s total health spending goes to treatment of chronic and complex disease in a relatively small number of patients.  Not surprisingly, for at least 20-30 years providers, health plans, foundations, government and academic health centers have attempted to develop new methods for managing the care of these patients; methods which would both improve quality and contain costs.  A recent article in The American Journal of Managed Care gives preliminary data on a randomized trial involving one of these approaches.  (Research Article)

The approach, referred to as a Guided Care, uses a trained nurse to coordinate patients’ care within a team-oriented practice model.   The nurse does assessments, creates an evidence-based care guide, monitors and coaches the patients, coordinates providers and care transitions, helps patients self-manage care and works with family caregivers.  Each nurse handles about 50-60 patients.

 The trial compares this method to usual care in several practices in the Washington, DC area.  The patients are all over 65 and have high morbidity scores.  The preliminary results indicated an annual savings of around $1500 per patient, including the cost of providing the Guided Care.  The savings are primarily attributable to fewer hospital days, and interestingly, more physician visits were used in the Guided Care group. 

The savings may seem modest, but only a few months of results were included.  The trial in ongoing and a full analysis may reveal greater savings.  In addition, while no specific health outcomes are reported, both physicians and patients ranked the guided care higher than usual care.  Among other things, the study demonstrates the ability of an uninhibited private sector to develop workable solutions to crucial health issues.