As researchers at the University of Washington in Seattle discovered in a study of patients at 14 clinics affiliated with Group Health Cooperative, a 600,000-enrollee integrated plan in Washington state, patients with chronic disease, such as diabetes and coronary heart disease, who also have depression have a much tougher time managing their illnesses.
But in a December 2010 article published in the New England Journal of Medicine, the researchers showed that dedicated, coordinated case management, in which patients had structured visits to a clinic every two or three weeks to manage depression and other illnesses, improved their medical disease control.
One of the coauthors, Elizabeth Lin, MD, MPH, says that this population receiving care management has high health costs, and researchers are just starting to analyze cost data over a two-year period.
So far, Wachter says, there isn’t much information about whether these programs are cost-effective. But now that hospitals and doctors are threatened by cuts in reimbursement for higher rates of admissions and readmissions, they may want to become much more engaged with the idea of a patient navigator.
“There’s going to be a shakeout in the next five years with these case manager models to determine empirically which ones work best,” he says.
Hospital and physician leaders need to understand that now, Wachter says, their “skin is in the game, through admissions or readmissions, and reporting on quality.”