Chronic care management of three ailments could save Medicare billions

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Even modest improvements in continuity can lead to substantial savings.

A new study provides further evidence that improving patient care coordination can result in better outcomes and lower healthcare costs, especially among patients with chronic diseases.

A team of researchers followed approximately 296,000 Medicare patients with congestive heart failure, chronic obstructive pulmonary disease, or diabetes for a 12-month period spanning 2008 and 2009. Their objective was to measure costs differences associated with care continuity during episodes of care.

Using a tool known as the Bice-Boxerman continuity of care index, which determines how well a patient’s care is coordinated among different providers, the researchers found that even modest improvements in continuity of care resulted in fewer emergency department visits, lower rates of complications, and reduced overall costs for episodes of care.

Peter Hussey, PhD, the study’s lead researcher and a senior policy researcher at Rand Corporation, estimates that Medicare could save $1.5 billion annually if patients with the three conditions received at least the median level of care continuity observed in the study.


Peter Hussey, PhD“Improving the coordination of care for patients with chronic illnesses can be difficult to achieve, but our findings suggest that it can have benefits for patients and the healthcare system,” Hussey says in a RAND press release.

Care coordination has been identified as a priority area by the Institute of Medicine, and many of the new payment and patient care models, such as the Patient-centered Medical Home, are premised on close care coordination. Earlier studies have shown that patients who had a close, continuous relationship with a physician were more likely to receive recommended medical care. Many programs designed to improve care coordination have not lowered costs or improved outcomes, however.

Results of the study were published online March 17 by JAMA Internal Medicine.