At some point (with patients at lower risk of needing expensive healthcare services) there is a point of no return. But we didn't find it in this program," Wennberg says.
After 12 months, 10.4% of the enhanced support group and 3.7% of the usual support group received the telephone intervention, the authors wrote.
The study found that after one year, costs for facility and professional services were $8.48 per person per month lower in the enhanced support group than in the usual-support group. Pharmacy costs were 52 cents per person per month higher in the enhanced support group. The program's costs were $2 per month. "The net savings was $6 per person per month."
The field of care management has been filled with controversy and debate, with many studies showing mixed results. One comprehensive study of 15 care-coordination demonstration projects by the Centers for Medicare and Medicaid Services found significant cost reduction benefit in only two, and the savings were so low they didn't cover the projects' costs.
Another meta-analysis showed that care support improves clinical outcomes, "but has mixed effects on cost or resource utilization," Wennberg wrote.
Participants were employees with one of three types of health insurance who worked in seven geographically and occupationally diverse organizations, but the authors cautioned that the results may not be generalizable to other interventions but Health Dialog has expanded it to the general population.
Care support has been proposed as one component of the remedy for runaway health care costs," Wennberg and colleagues wrote. "This study shows that an analytically driven, targeted, population-based program can decrease hospitalization and surgical procedures and thereby reduce total medical costs for the population as a whole."
One important way in which the study showed that this kind of coaching saves costs was in the way coaches assisted patients with decision support, explains Wennberg, who also is a member of the Dartmouth Atlas Working Group team.
Health Dialog Services Corporation markets its coaching program to a variety of plans. The data and trial design was reviewed by an independent third party prior to publication.