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Care Management Showing Promise, Group Says

Care management programs, which combine information technology, patient-centered nursing and care coordination, have helped Alliance of Community Health Plan (AHCP) members cut costs and improve patient care, the group said in a report released Wednesday.

For example, the Group Health Cooperative in Seattle has reported more than $2.5 million in cost savings during the first seven months of this year for its 8,224 patients in complex case management and 1,831 patients in regular case management. Tufts Health Plan in Massachusetts and Rhode Island found that every $1 spent on obstetrical case management for women at high risk for preterm delivery saved $4.50, and on-site and telephone review of hospital utilization saved $4.80 per dollar spent.

The group represents 22 not-for-profit, community-based and regional health plans and provider organizations. The ACHP report says the case management techniques the plans have used included helping patients and caregivers manage medical conditions and psychosocial problems more effectively, coordinating care, reducing duplication of services and reducing the need for expensive medical services.

“Complex, chronically ill patients have traditionally been the most expensive and difficult to treat; almost half of all health care spending in the United States goes to only five percent of patients, many of whom have multiple health conditions as well as social, environmental or financial barriers to good health,” AHCP President and CEO Patricia P. Smith notes in the report. “Such patients often need and benefit from personalized care, tailored to their individual needs; care management nurses, many of whom work in partnership with social workers, nutritionists, pharmacists and other staff, can step in to supplement the care patients are receiving at their physicians’ offices.”