Tim Reynolds, MD
Does care coordination for Medicare beneficiaries with chronic conditions improve quality of care and reduce Medicare costs?
15 randomized controlled trials (Medicare Coordinated Care Demonstration). ClinicalTrials.gov NCT00627029.
1 to 4 years (mean 30 mo).
15 various health care settings in the USA.
18 402 patients (181 to 2657 patients per program) covered by fee-for-service Medicare (78% aged 65 to 84 y; 55% women) who had ≥ 1 chronic condition (e.g., coronary artery disease 61%, heart failure 48%, diabetes 39%, and chronic obstructive pulmonary disease 32%). Each program defined its own target population.
9427 patients were assigned to care coordination (each program designed its own intervention) and 8975 to usual care. Although the interventions differed, most involved a care coordinator assigned to each patient who assessed patient needs, developed patient care plans, educated patients to improve adherence, and improved care coordination.
Hospital admissions, Medicare expenditures (including negotiated program fees of mean $235/member per mo but not including prescription drugs), and quality-of-care measures. A P value < 0.10 was considered statistically significant.
100% (intention-to-treat analysis).
Because of differences in populations, interventions, and practice environments, results were presented separately for each of the 15 care coordination programs (Table). 2 programs showed reductions in hospital admissions by 17% and 24%; 1 program showed a 19% increase. The intervention was probably cost neutral in 2 programs, unlikely to be cost neutral in 4 programs, and more costly than usual care in 9 programs, by 8% to 41%. In most programs, groups did not differ for receipt of preventive services (based on Medicare claims data).
Most care coordination programs for Medicare beneficiaries with chronic conditions did not reduce hospitalizations, improve care, or reduce costs.
Care coordination vs usual care for Medicare beneficiaries with chronic conditions†
†Values are range of results in 15 separate trials.
‡Including care coordination fees.
Reynolds T. Care coordination for patients with chronic conditions did not reduce hospitalizations or Medicare costs. Ann Intern Med. 2009;150:JC6–14. doi: 10.7326/0003-4819-150-12-200906160-02014
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Published: Ann Intern Med. 2009;150(12):JC6-14.
Healthcare Delivery and Policy, Hospital Medicine.
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