The articles describe the barriers to, the potential for greater adoption of managing complex care -
The care of patients with complex medical needs is widely considered one of the key factors has increased the health of US costs, and it is generally accepted that 10 to 15 percent of Medicare patients represent 65 to 75 percent of all Medicare spending. Many of the country's largest health care organizations have been adopting the complex care management strategy - assembling multidisciplinary teams of physicians, nurses, pharmacists, mental health professionals and others with services coordinated by care managers who work closely with patients and their families.
perspective in an article in the August 7 New England Journal of Medicine and a brief question Commonwealth Fund released today, two Massachusetts General Hospital (MGH) physicians and their authors describe cooperation best practices based on interviews with leaders of 18 complex care management programs, discuss barriers to wider adoption of managing complex care and describe possible strategies to overcome these barriers.
"Not only can fully meet the needs of complex care patients keep healthier, but it can also reduce costs by avoiding emergency department visits and unnecessary hospitalizations," says Clemens Hong, MD , MPH, of the MGH Division of General medicine, corresponding author of the NEJM paper. "in our part of Perspective, we wanted to clarify some of the needs and challenges of establishing the management of complex care and review possible solutions if you work in a large integrated health system in Boston or a small doctor's office in rural Arkansas. "
The report of the Commonwealth Fund, Hong and his co-authors - Timothy Ferris, MD, MPH, vice president, health management of the population, at MGH and Partners HealthCare System and Allison Siegel , MPH, formerly with the Stoeckle Center for primary care innovation at MGH. - examine the characteristics of effective care management programs Foremost among these are the close cooperation of care managers with all suppliers taking . care for a complex patient They note that small, one and two primary care physicians may lack the resources to manage complex care in cases like this, regional organizations -.
in Article NEJM, Hong, Ferris and Melinda Abrams, vice president can provide the infrastructure for the management of care remains closely linked to suppliers known to patients. - public or private, reform of the delivery system, the Fund Commonwealth noted that the main obstacle to wider adoption of care management is the system of remuneration payment services, offering little or no support for essential care management functions. Instead, reimbursement systems that provide global payments covering all services requires a complex patient or those who share cost savings between the payers and providers can have better options. Another option that offers, for a monthly fee of patient care management could encourage the participation of suppliers unable to bear the financial risks of international payments agreements. Other obstacles include the startup costs associated with staff training and new information technologies which could be covered by additional payments. Unrealistic expectations for a rapid return on investment could be addressed by increasing the duration of payer-provider contracts.
The MGH embarked on care management in 06, a Center for Medicare and Medicaid Services (CMS) -sponsored demonstration project that enrolled 2500 patients at high risk in its first phase. Through the coordination of care nurse managers who worked closely with registered patients and their doctors, the program realized a net annual savings of 7 percent and a return on investment of $ 2.65 for every dollar at least spent. CMS has renewed the project in 09, and now more than 10,000 complex patients in eastern Massachusetts have a care manager in the Partners HealthCare Integrated Care Management Program.
"We have many small practices in the Partners system that often not enough complex patients to invest in complex care management resources themselves," said Hong "as a system of integrated delivery, Partners has the ability to support these practices by providing care managers who can work two or three days a week in many different practices. Not all the complex patient needs for each service while sharing resources that are deployed only when and where necessary can achieve significant economies of scale. "
He and his co-authors also note the need for more information on how best to match the program design different practice settings; programs and training standards; and advanced analytics and information technology to help identify appropriate patients, provide real-time data and improve workflow. Increasing evidence on the savings provided by complex care management should increase its adoption, that compensation programs not only for themselves, but also to improve health outcomes and reduce fragmentation of patient care .
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