Here is an interesting article from The Wall Street Journal Health Blog. This article is fairly long, so only part of it is below. Please click over and read the article completely. Here is an example of “thinking outside of the box” to try to accomplish better outcomes for some of the patients that seem to fall through the cracks or worse, who just give up entirely.
Let me know what you think, won’t you? There are some interesting comments at the original site, also.
By Katherine Hobson
Offering telephone health coaching to a broader-than-usual swath of patients may save money, according to a study just published in the New England Journal of Medicine.
Typically this kind of care management, as it’s called, is offered to people who have trouble managing their chronic conditions or who are facing a big treatment decision — such as surgery or medical management for lower back pain. But a randomized study conducted by Health Dialog Services compared that approach to its own program, which offered phone-based health coaching to a larger proportion of those folks and also to some “chaotic users of the health-care system” — people who don’t have a chronic illness but, for example, seem to turn to the ER for all their routine care, David Wennberg, one of the study’s authors and chief science and products officer at Health Dialog, tells the Health Blog.
The study randomly assigned a patient population of 174,120 people to either the traditional support or enhanced support programs. The former, with its more limited criteria, enrolled 3.7% of its patient pool; the latter enrolled 10.4% of its own pool. The support was the same in both groups: helping with behavior changes such as exercise as well as offering shared decision making tools intended to give patients the pros and cons of treatments they’re considering. (Shared decision making is the approach many say should be used in prostate cancer, for example, given its complex array of treatment options.)
Average monthly medical and pharmacy costs were 3.6% lower across all the patients in the enhanced support group compared to the usual-support group. In other words, says Wennberg, if employer A’s company used the enhanced model, it would save an average of $7.96 per employee compared to employer B, using the more restrictive traditional model.
Of course, we should note here that it would be to Health Dialog’s benefit if companies extended these services, at $2 per person, to a greater proportion of their workers.
We wondered if patients are suspicious that the phone coaching was biased in favor of cheaper treatments, whatever their appropriateness for the patient. Wennberg says the decision making tools are created by the nonprofit Foundation for Informed Medical Decision Making. Here’s a description of their partnership.
And we also wanted to know whether doctors are agitated when patients receive outside health coaching about treatments. “The goal of this is to have a well-informed patient talking to a well-informed physician, preferably his or her own primary care physician,” says Wennberg…[read the rest of the article]…
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- “Lowering Health Care Costs By Calling People” and related posts (wonkroom.thinkprogress.org)
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- Study: Broader Telephone-Based Health Coaching May Save Money (blogs.wsj.com)