A recent editorial in the New England Journal of Medicine makes a strong case for technology-assisted care coordination. As Matthew J. Press, a doctor at Weill Cornell Medical College, describes the case of Mr. K, a 70-year-old patient with liver cancer and kidney stones, it becomes clear that his complex series of interrelated procedures and office visits involving 11 other clinicians wouldn't have been possible without healthcare IT.
As his primary care doctor, Dr. Press coordinated Mr. K's 80-day journey through the healthcare system with the help of 32 emails, eight phone calls, and access to clinical data in the patient's electronic medical record. This IT-enhanced collaboration among several medical practitioners let Dr. Press detect electrolyte imbalances, adjust the patient's medication regimen as his condition changed, and ensure that he received the surgery he needed.
Several independent reports confirm the therapeutic value of this kind of care coordination. Four of 11 programs that were part of the Medicare Coordinated Care Demonstration, for instance, were able to cut hospital admissions by as much as 33% among high-risk patients. They accomplished that feat with the help of nurses who acted as care coordinators, assessing patients, developing care plans, and pinpointing special needs and gaps.
[As more and more data becomes available, a key question remains. Read Who Owns EHR Data?]
The RNs also spent time teaching patients about the value of adhering to treatment regimens and closely monitored them over the course of the study. Some programs also encouraged physicians to adhere to evidence-based clinical guidelines or had the care coordinators alert them about patients who weren't taking their medications or receiving preventive care.
But the bad news was none of the programs "generated net savings to Medicare," according to Randall S. Brown, director of health research at Mathematica Policy Research in Princeton, N.J. And because these were demonstration projects, they were designed to last for a fixed period to determine if the interventions worked. Then they were stopped.
Similarly, the National Center for Policy Analysis points out that among 29 Medicare-sponsored care coordination programs, only one reduced Medicare spending.
So what are we to make of this good news/bad news situation? As I've written before in this column, we desperately need to rein in our overpriced healthcare system, but the fact that we still haven't worked out the exact economic equation shouldn't stop healthcare stakeholders from forging ahead. While care coordination efforts won't always reduce costs, there's little doubt they save lives. And there are in fact programs that do move the needle toward cost effectiveness.
SaferMD is one of the most promising. SaferMD is a care coordination/collaboration system with one simple goal: Decrease communication glitches that can endanger patients. Anyone who has spent time in a hospital knows those dangers: The same medication is incorrectly given to the same patient twice in one hour; critical test results arrive on a doctor's desk after they're of no use in making a life-saving diagnosis… the list goes on. In the US, failure to communicate test results generates about $5 billion in malpractice awards. SaferMD has provided subscribers with several tools that reduce that number.
The SaferMD software accomplishes this feat by looking at test result reports as they move through a health system. By monitoring test result notifications as they move from the laboratory to clinicians, it can verify that the right tests reach the right person and, more importantly, that a clinician actually views the data in a timely fashion. The company says it saves healthcare providers serious money by lowering the cost of their malpractice insurance premiums. It estimates that a midsized provider is likely to save about $1 million a year by using this auditing system.
Care coordination may not be the economic panacea policy makers had hoped it would be, but it's having a major impact where it really counts.
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