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Case Management yields 2-to-1 ROI   
IT boosts case management efforts
US Health System Ranks Last Compared to Other Countries: Studies

Case management yields 2-to-1 ROI
by Patty Enrado, Contributing Editor, 03/01/07

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.

Hospital-based case management's patient-centric approach places one person in charge of coordinating all phases of patient care from admission through discharge.

Lisa Camplese, a nurse and vice president of clinical quality and care coordination at Centura, says IT is a must-have for efficient patient case management and discharge planning.

“You can put together a clinical review summary in a matter of minutes,” she said.

 “It provides a snapshot of what's happening day by day as they progress through the hospital stay,” Camplese said. “It provides payers with justification for why they need hospital care.”

Case management is playing an increasingly critical role in hospitals and is being recognized as vital by hospital administrators, putting case management directors in a better position for IT funds to leverage decision-making and increase staff productivity, said L. Greg Cunningham, CEO of the American Case Management Association.

“Case management's ability to improve quality while adding to the bottom line makes it an influential and depended-upon service,” Cunningham said. “Therefore, more budget monies have been allocated to case management.”

Cheri Lattimer, executive director of the Case Management Society of America, agrees. Morever, she said, case managers are being recognized by key players in patient care and today play a more collaborative role than ever.

“It is through these collaborative ventures that case management will be acknowledged as the glue that ensures care coordination in a progressively more complex healthcare maze,” she said. IT is playing an increasingly important role, she added.

Centura operates 12 hospitals, eight senior residences and home care and hospice services. A few months ago it rolled out case-management specific technology developed by Chicago-based ECIN (Extended Care Information Network).

At about the same time ECIN also signed on two divisions of the Hospital Corporation of America (HCA), Atlanta-based Emory Health System, St. Louis-based Barnes-Jewish and Christian (BJC) Health System and the Oklahoma University Medical Center.

ECIN provides Web-based technology that helps coordinate fragmented health services and utilization information into a single screen, which then communicates automatically to payers and post-acute care providers.

Automating post-acute facility referrals eliminates the cumbersome and costly process that has a case manager or discharge planner wasting hours every week phoning and faxing to secure post-acute care services one provider at a time, said ECIN CEO Jeff Surges.

Instead, the ExtendedCare Professional application sends a detailed electronic referral across ECIN's proprietary database of 86,000 providers and interested facilities reply – often within minutes.

“By automating the entire process, we expect to decrease the manual time and effort involved in completing paper-based forms and communicating via fax and phone to our payers and post acute care providers, leaving more time for our clinical staff to focus on patient care,” Camplese said.

The studies by the Commonwealth Fund found that the United States, which has the most expensive health system in the world, underperforms consistently relative to other countries and differs most notably in the fact that Americans have no universal health insurance coverage.

“The United States stands out as the only nation in these studies that does not ensure access to health care through universal coverage and promotion of a ‘medical home' for patients,” said Commonwealth Fund president Karen Davis.

“Our failure to ensure health insurance for all and encourage stable, long-term ties between physicians and patients shows in our poor performance on measures of quality, access, efficiency, equity, and health outcomes.”

In “Mirror, Mirror on the Wall: An International Update on the Comparative Performance of American Health Care”, the study focused on interviews with physicians and patients in Australia, Britain, Canada, Germany, New Zealand and the United States who were asked to speak about their experiences and views on their health systems.

The US ranked last in most areas, including access to health care, patient safety, timeliness of care, efficiency and equity. Americans were also last in terms of whether they had a regular physician.

“The US spends twice what the average industrialized country spends on health care but we're clearly not getting value for the money,” Davis told AFP.

She also noted that 45 million Americans, or 15 percent of the US population, have no health insurance, which contributes to the country's medical woes.

The United States is also far behind in adopting modern health information technology, which translates into spiralling costs and poor care.

“We pride ourselves on being advanced on so many areas of technology but it's not the case on health information technology,” Davis said. “Other countries have just moved ahead.”

Britain got the top score in overall ranking among the countries in the study, followed by Germany. New Zealand and Australia tied for third followed by Canada and the United States.

The second study delves into why health costs in the United States are so much higher than in eight other countries of the Organization for Economic Cooperation and Development: Australia, Britain, Canada, France, Germany, Japan, the Netherlands and New Zealand.

The study, “Multinational Comparisons of Health Systems Data,” found that even though the US spends the most on publicly and privately financed health insurance, its citizens had the most potential years of life lost due to circulatory and respiratory diseases as well as diabetes.

“This study blows a lot of myths about the US health system,” Davis said. “We spend three times what the average country spends on a day of hospital care and we also spend twice what the average country spends on prescription medication.”

Health care is likely to be a prominent issue in the 2008 US presidential elections with various candidates already promising to tackle rising costs and the burden placed on big business to provide health insurance .