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Continuity of care cuts Medicare costs
Improving the coordination of care for elderly patients with chronic diseases reduces costs, use of health services and complications, according to a new RAND Corporation study published online in JAMA Internal Medicine.
Researchers studied nearly 300,000 Medicare patients with diabetes, congestive heart failure or emphysema and found that even modest improvements in the continuity of care were associated with sizable reductions in use of hospital emergency departments and hospitalizations. Patients with chronic illnesses often experience poorly coordinated care; they may see different healthcare providers working in multiple clinical locations and experience poor communication. These factors can lead to higher use of health services and poorer outcomes.
Improving coordination of care for patients with these illnesses could save Medicare as much as $1.5 billion per year, the research suggested.
“Continuity of care has long been one of the tenets of high-quality primary care,” says Benjamin Littenberg, MD, chief medical officer, Patient Engagement Systems. “This carefully done analysis of Medicare patients with common chronic problems shows a very consistent effect: The more care the patient receives from a single provider, the better the outcomes. Patients with relatively frequent contact with a single-usually primary-provider are less likely to need emergency room or hospital care. The data support the idea that switching one visit per year from a specialist to the primary provider is associated with about a 5% reduction in complications, hospitalizations and total costs.
“Although the quality of these contacts cannot be ascertained from claims data, here is yet more data that engaging the patient with a primary source of care results in better outcomes and lower costs,” Dr. Littenberg continues. “This report is very consistent with controlled trials of systems to increase patient engagement with their primary care providers. They also showed substantial reductions in ER visits, hospital use and costs while increasing primary care visits.”
Care coordination has been identified as a priority by the Institute of Medicine and the National Priorities Partnership. Previous studies show that patients with a close, continuous relationship with a physician are more likely to receive recommended care, but many programs that aim to improve coordination of care have not reduced costs or improved quality.
The study used a standard measure of continuity of care to determine how well care was coordinated among different providers. Care was deemed to be better coordinated if patients saw fewer providers or if visits were concentrated among fewer providers.
Researchers found that patients with better continuity of care were less likely to be hospitalized and visit hospital emergency departments, and had lower rates of complications and overall costs for episodes of care.