An article in the May 2017 issue of Health Affairs, Bending The Spending Curve By Altering Care Delivery Patterns: The Role Of Care Management Within A Pioneer ACO by John Hsu and others from the Massachusetts General Hospital and Partners HealthCare in Boston, provides more evidence that care management interventions can meaningfully contribute to the performance of an ACO. Doing so, however, is neither fast nor easy.
Here are a few key takeaways (which parallel my own experience):
1. Target higher-risk populations with modifiable risk factors which your program is specifically designed to address
2. Stay constant to purpose … utilization (ER visits and hospitalizations) may even go up at first … but will, as participants are in the the care management program longer, progressively decline over time (most notably at 13+ months)
3. Sophisticated analytics and study designs are required to assess the impacts of such programs in ‘real-world’ implementations (i.e., without a randomized controlled trial)
4. Inability to serve the entire target population should not deter continued implementation – enroll as many as current resources permit and continue to work toward expanding capacity
The care management program described in the article shares some attributes with HQP’s Advanced Preventive Care model. One of the authors of the Health Affairs article was also an author on a 2014 issue brief for the Commonwealth Fund that identified HQP’s model as one of four (out of 18 successful models reviewed) having the highest quality evidence of effectiveness in managing populations with complex chronic disease. The details of a care management program’s design and implementation are critical to its success, with many varieties of “generic” care management have been found to be ineffective.
While not quick or easy, the path to improving population health – from both a health outcomes and cost perspective – is becoming clearer. The advantage will go to those with the know-how, relentless commitment to innovation, and constancy to purpose.