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Reductions in Costly Healthcare Service Utilization: Findings from the Care Advocate Program
Author(s) -
Shan George R.,
Wilber Kathleen H.,
Allen Douglas
Publication year - 2006
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.2006.00799.x
Subject(s) - medicine , intervention (counseling) , family medicine , health care , managed care , odds ratio , randomized controlled trial , gerontology , health plan , service (business) , health maintenance , odds , nursing , logistic regression , surgery , economy , pathology , economics , economic growth
OBJECTIVES: To determine whether a telephone care‐management intervention for high‐risk Medicare health maintenance organization (HMO) health plan enrollees can reduce costly medical service utilization. DESIGN: Randomized, controlled trial measuring healthcare services utilization over three 12‐month periods (pre‐, during, and postintervention). SETTING: Two social service organizations partnered with a Medicare HMO and four contracted medical groups in southern California. PARTICIPANTS: Eight hundred twenty‐three patients aged 65 and older; eligibility was determined using an algorithm to target older adults with high use of insured healthcare services. INTERVENTION: After assessment, members in the intervention group were offered mutually agreed upon referrals to home‐ and community‐based services (HCBS), medical groups, or Medicare HMO health plan and followed monthly for 1 year. MEASUREMENTS: Insured medical service utilization was measured across three 12‐month periods. Acceptance and utilization of Care Advocate (CA) referrals were measured during the 12‐month intervention period. RESULTS: CA intervention members were significantly more likely than controls to use primary care physician services (odds ratio (OR)=2.05, P <.001), and number of hospital admissions (OR=0.43, P <.01) and hospital days (OR=0.39, P <.05) were significantly more stable for CA group members than for controls. CONCLUSION: Results suggest that a modest intervention linking older adults to HCBS may have important cost‐saving implications for HMOs serving community‐dwelling older adults with high healthcare service utilization. Future studies, using a national sample, should verify the role of telephone care management in reducing the use of costly medical services.