Case management yields 2-to-1 ROI

By Patty Enrado
12:00 AM

SAN FRANCISCO – Recently released results of an 18-month study of Blue Shield of California’s case management program for HMO members diagnosed with late-stage illnesses showed a two-to-one return on investment.

A Carnegie Mellon University-led study concluded that BSC’s comprehensive, community-based, patient-centered management reduced hospital admissions by 38 percent, hospital days by 36 percent and emergency room visits by 30 percent, thereby reducing overall costs by 26 percent.

 “The take-away from this study is that you need an ultra-high touch focus for members at this end of the spectrum,” said Andrew Halpert, MD, senior medical director for the health plan. “It’s not cheap, but it’s the right thing to do. Now we know the return. If you tailor it and do it right, it can more than pay for itself.”

Study co-author Latanya Sweeney, associate professor of computer science technology and policy at Carnegie Mellon University, agreed. “Any effort that lowers healthcare cost while maintaining quality is worthy of consideration,” she said. “This is a great example of how a comprehensive PCM can serve as a model for Medicare to provide individualized medicine in a more humane and economical way.” The study, which was co-authored with BSC’s Halpert and Joan Waranoff, appeared in the February issue of The American Journal of Managed Care.

Tom Hagan, CIO of ParadigmHealth, provider of the management services, said the technology platform integrated the data and provided daily acute surveillance for real-time, full view of a patient’s history.

Community-based nurses were connected via the Internet. The documentation system gave the nurses the tools to establish and manage individual care plans in a structured way. “A community-based model will dramatically improve patient satisfaction and outcomes with very large recurring savings,” said Hagan. BSC completed its analysis in late 2004. “We knew enough on our own that it was producing value,” Halpert said.

Patient satisfaction has been “extremely solid,” said Halpert. Coordination, support and education play important roles in patient-centered managements at a time when patients and their families are often overcome with dealing with late-stage illnesses.