A Re-Look at Care Coordination in Medicare

Care management and care coordination for fee-for-service Medicare beneficiaries have not shown much in the way of cost savings in demonstration projects.  This is in stark contrast to Medicare Advantage where private health plans routinely seem to significantly reduce spending through various care management techniques.  A new study attempts to ascertain whether one aspect of care coordination–continuity of care–is associated with spending reductions for Medicare beneficiaries with congestive heart failure, diabetes and chronic obstructive pulmonary disease.   (Annals Article)   The researchers used data from 2008 and 2009 and applied a common index for measuring continuity of care, primarily by comparing the number of total outpatient visits and number of different providers visited.  Most of these patients did appear to see more than one provider and the patients with the highest risk scores tended to see more providers.  For each of the three conditions, higher COC scores, indicating fewer providers visited or more care from a single provider, were associated with significantly fewer hospitalizations and ER visits, as well as fewer complications of care.  Greater levels of continuity of care were also associated with lower spending.  While there could be methodological quibbles with the study, the outcome is consistent with common sense.  If more of a patient’s care is delivered by a single provider or single set of providers, then those providers should have a greater familiarity with the patient and there should be less need for repeat testing and less opportunity for miscommunication of basic health and health care data.  The authors do not, however, suggest how Medicare might encourage or incent patients and providers to increase continuity of care.