M.D. Phone Home: Using Telephone-based Care to Cut Costs

Can phone calls help cut healthcare costs? Quite possibly, according to findings published in the New England Journal of Medicine.

In the study, researchers found that a targeted telephone-care management program in which nurses make calls to high-risk patients offering information on the risks and benefits of different therapeutic options can help cut medical costs and hospitalizations if offered on a larger scale.

Although care management is typically confined to patients who have difficulty managing chronic conditions or those facing big treatment decisions, this study found that expanding the target consumer pool to include patients who turn to the ER for routine care can help cut healthcare tabs.

And while telephone interventions designed to promote self-management skills and improve patient-physician communication have been shown in previous studies to increase patient satisfaction along with use of preventive services, the effect on healthcare costs and resource utilization had not been determined.

To that end, David E. Wennberg, MD, MPH, of Health Dialog Services in Boston, MA, and colleagues conducted a randomized study of 174,120 subjects; those with selected medical conditions were contacted by health coaches, who predicted the high health care costs required to teach them about shared decision making, self-care, and behavioral changes. Subjects were randomly assigned to either a usual-support group or an enhanced-support group; although the same telephone intervention was delivered to the two groups, a larger number of subjects in the enhanced-support group “were made eligible for coaching through the lowering of cutoff points for predicted future costs and expansion of the number of qualifying health conditions.”

According to an article published in The Fiscal Times, the call center staff also used electronic records to identify patients considering prostate, hip, knee, back or uterine surgery, and coronary revascularization. Patients were sent Web links, video, and print materials before the operation comparing the risks and benefits of surgery with options like watchful waiting, bed-rest, anti-inflammatory drugs, and diet and exercise changes.

After one year, 10.4% of the enhanced-support group and 3.7% of the usual-support group received the telephone intervention. According to researchers, the average monthly medical and pharmacy costs per person in the enhanced-support group were 3.6% ($7.96) lower than those in the usual-support group ($213.82 vs. $221.78); a 10.1% reduction in annual hospital admissions (P<0.001) accounted for most of the savings. In total, the cost of the intervention program was less than $2.00 per person per month.

The program, the authors concluded, was successful in reducing medical costs and hospitalizations in this patient population.

“This shows that if done well, with a total population approach, you really can improve quality and reduce costs in a way where members have tremendous satisfaction,” said Wennberg in Fiscal Times. “We’re not reducing costs through increased copays or by having second opinions from doctors. It’s saying the patients have the best second opinion. It’s a patient friendly model.”

For more:

• New England Journal of Medicine—A Randomized Trial of a Telephone Care-Management Strategy
• Wall Street Journal—Study: Broader Telephone-Based Health Coaching May Save Money
• American Journal of Managed Care—Time Allocation and Caseload Capacity in Telephone Depression Care Management