Solid evidence is often missing to support the cost-saving effect of many wellness, disease management and care management programs. New research reported in the NEJM builds a firmer foundation for good cost outcomes from these programs. A care management vendor conducted a randomized trial of over 170,000 patients from seven employers who had previously been using the vendor’s services. The coaching-style intervention was the same for each of the two trial arms, but a larger cohort was selected for one group. This cohort was selected by reaching deeper into the pool of people with high costs or who were predicted to be at risk for future disease. (NEJM Article)
About three times as many people were targeted and coached in the enhanced targeting group as in the normal targeting one. The coaching support was the same for both groups and largely was conducted by telephone, with internet and print supplemental information. The coaches helped teach good health decision-making and self-management and focused on medication adherence, complying with hospital discharge instructions and behavioral change. The primary outcomes were cost of care and utilization of health services, particularly inpatient hospital. Overall, medical expenses were about $8.48 per patient per month lower in the higher targeted group, pharmacy costs were about 52 cents higher, overall savings were therefore about $8, with a cost of the intervention of about $2.00, which appears to be the vendor’s actual cost, not the charge to the employer. Net savings were around $6 pmpm or about 4% of health care costs.
Much of the savings came from less use of highly-variable treatments and expensive preference sensitive services. Issues with the study might include its short duration, the lack of a true control group with no intervention to check for any placebo effect, and the method of calculating the cost of the intervention. It is unlikely the employers were actually being charged as little as $2 per member per month and an employer’s net return would be based on what they were paying the vendor for services. Overall, however, the study indicates that a well-designed, relatively broad intervention can provide substantial savings, which should continue over longer periods.