RWJF Content Alert -- Care Management: Cutting Costs, Not Corners

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Two New Papers Suggest That Strong, Effective Care Management Models—when delivered to the right people—Can Reduce Hospitalizations and Possibly Costs

Featured in the June issue of Health Affairs, both papers highlight findings from the Medicare Coordinated Care Demonstration, a Centers for Medicare and Medicaid Services (CMS) project. The project tested whether providing care management services to beneficiaries in 15 fee-for-service programs either reduced total Medicare spending, or increased the quality of health care services and satisfaction of both beneficiaries and providers, without increasing spending.  

Deborah Peikes and her co-authors at Mathematica Policy Research found that the demonstration team at the Washington University School of Medicine in St. Louis successfully reduced patient hospitalizations by 12 percent, and monthly Medicare spending by $217 per enrollee, more than offsetting the program’s monthly $151 care management fee.

Read the paper.

In a second paper, Mathematica’s Randall S. Brown and his colleagues found that four of the demonstration programs were able to reduce hospitalizations by eight to 33 percent among Medicare enrollees who had a risk of near-term hospitalization.

Read the paper.

Funded by the Robert Wood Johnson Foundation’s Changes in Health Care Financing and Organization (HCFO) program, the findings suggest that whether medical homes, accountable care organizations, communities, or payers implement such programs, net savings are possible with the proper targeting, program design, and fee structure.