Guided Care Program Could Save Medicare $15 Billion
a Year on Chronically Ill Seniors
Studies say Guided Care improves quality of patients' care, reduces family caregiver strain and improves
physicians' satisfaction with chronic care
Aug. 7, 2009 - The nation's sickest and most
expensive patients – senior citizens with chronic conditions - need
fewer health care resources and cost Medicare and insurers less when
they are closely supported by a nurse-physician primary care team that
tracks their health and offers regular support, according to a study by
researchers at the Johns Hopkins Bloomberg School of Public Health.
The new research, published in the American
Journal of Managed Care, found that in the first eight months of a
randomized controlled trial, patients in a primary care enhancement
program called "Guided Care" spent less time in hospitals and skilled
nursing facilities and had fewer emergency room visits and home health
episodes.
"Guided Care patients cost health insurers 11
percent less than patients in the control group," said Chad Boult, MD,
MPH, MBA, the principal investigator of the study and creator of the
Guided Care model.
"If you apply that rate of savings to the 11
million eligible Medicare beneficiaries, programs like Guided Care could
save Medicare more than $15 billion every year," added Boult, who is
also the Eugene and Mildred Lipitz Professor in Health Care Policy at
the Bloomberg School and director of the Lipitz Center for Integrated
Health Care.
Compared to patients who received usual care,
Guided Care patients experienced, on average -
● 24 percent fewer hospital days,
● 37 percent fewer skilled nursing facility days,
● 15 percent fewer emergency department visits and
● 29 percent fewer home health care episodes.
"While Guided Care patients received more personal
attention from their care team and had more physician office visits, the
avoided expenses related to care in hospitals, skilled nursing
facilities and emergency departments more than offset all the costs of
providing Guided Care," said lead author Bruce Leff, MD, associate
professor in the Bloomberg School's Department of Health Policy and
Management and associate professor in the Department of Medicine at the
Johns Hopkins School of Medicine.
"The program realized annual net savings of $75,000
per nurse, two thirds of which resulted from reductions in
hospitalization," Leff added.
Other studies have shown that Guided Care improves
the quality of patients' care, reduces family caregiver strain and
improves physicians' satisfaction with chronic care.
Guided Care is a model of proactive, comprehensive
health care provided by physician-nurse teams for people with several
chronic health conditions. It is a medical home for the growing number
of older adults with chronic health conditions.
This model is designed to improve patients' quality
of life and care, while improving the efficiency of treating the sickest
and most complex patients. The care teams include a registered nurse,
two to five physicians, and other members of the office staff who work
together for the benefit of each patient to:
● Perform a comprehensive assessment at home
● Create an evidence-based care guide and action
plan
● Monitor and coach the patient monthly
● Coordinate the efforts of all the patient's
healthcare providers
● Smooth the patient's transition between sites
of care
● Promote patient self-management
● Educate and support family caregivers
● Facilitate access to appropriate community
resources
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Health & Medicine for Senior Citizens
Cardiac Deaths of Seniors with Artery Disease Cut 73
Percent by Better Communications
Electronic health records, communications play key
role in keeping patients healthy two years after leaving program
 August 7, 2009 - An innovative program involving
mostly male senior citizens cut cardiac deaths by 73 percent by linking
coronary artery disease patients and teams of pharmacists, nurses,
primary care doctors, and cardiologists with an electronic health
record. The program also kept the patients healthy two years after they
left the program by keeping them in touch with their care givers
electronically, according to a study by Kaiser Permanente.
Read more...
|
About This Study
A multi-site, randomized controlled trial of Guided
Care involving 49 physicians, 904 older patients and 319 family members
recently concluded in eight locations in the Baltimore-Washington, D.C.
area. The three-year study was funded by a public-private partnership of
the Agency for Healthcare Research and Quality, the National Institute
on Aging, the John A. Hartford Foundation, the Jacob and Valeria
Langeloth Foundation, Kaiser Permanente Mid-Atlantic States, Johns
Hopkins HealthCare, and the Roger C. Lipitz Center for Integrated Health
Care.
Additional authors of "Guided Care and the Cost of
Complex Healthcare: A Preliminary Report" include Lisa Reider, MHS;
Kevin D. Frick, PhD; Daniel D. Scharfstein, ScD; Cynthia M. Boyd, MD,
MPH; Katherine Frey, MPH; from Johns Hopkins and Lya Karm, MD; from
Kaiser Permanente Mid-Atlantic States.
About Guided Care
The Guided Care model was developed by a team of
clinical researchers at Johns Hopkins University beginning in 2001. The
team is supported by a Stakeholder Advisory Committee, comprised of
national leaders in medicine, nursing, health policy, patient advocacy
and health insurance. Some have said that Guided Care and its attention
to the often overwhelming medical and non-medical needs of these
patients are like "having a nurse in the family." For more information,
please go to:
www.guidedcare.org.
About Johns Hopkins Bloomberg School of Public
Health
Johns Hopkins Bloomberg School of Public Health is
dedicated to the education of a diverse group of research scientists and
public health professionals, a process inseparably linked to the
discovery and application of new knowledge, and through these
activities, to the improvement of health and prevention of disease and
disability around the world. Additional information about the school and
its programs is available at
www.jhsph.edu.
About Medicare Medical Home Demonstration
Your Home for Medicare Medical Home Information
Welcome to MedHomeInfo, the resource for physicians and practices that
want to participate in the Medicare Medical Home Demonstration (MMHD).
Participating physicians will provide chronically ill patients with
convenient access to continuous healthcare services, including care
management, care coordination, and support for patient self-management.
This site provides resources and assistance for practices that wish to
provide these services and participate in the MMHD.
http://medhomeinfo.org/
Section 204 of the Tax Relief & Health Care Act of
2006 mandates a demonstration in up to 8 states to provide targeted,
accessible, continuous and coordinated care to Medicare beneficiaries
with chronic or prolonged illnesses requiring regular medical
monitoring, advising or treatment. A link to the legislation is provided
below.
>>
Tax Relief & Health Care Act of 2006
>>
Medicare Fact Sheet on Medicare Medical Home Demonstration Project
>> Visit the
Medicare Medical Home Demonstration site for practice application
information, instructions, and the application form.
