Continuity of Care Improvements Cut Costs

By improving continuity of care for elder patients with chronic diseases, the healthcare industry can cut costs, reduce the use of health services, and decrease complications, according to a new study.

The RAND Corporation study, published online on March 17 in JAMA Intern Med, titled “Continuity and the Costs of Care for Chronic Disease” found that even modest improvements in the coordination of care among patients with diabetes, congestive heart failure, or emphysema led to sizable reductions in hospitalizations and the use of emergency departments.

“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 both patients and the health care system,” Peter Hussey, the study's lead author and a senior policy researcher at RAND, said in a statement.

The investigators studied insurance claims from 2008 and 2009 for a 5% sample of Medicare beneficiaries experiencing a 12 months of care for three conditions: 53,488 patients with congestive heart failure (CHF); 76,520 experiencing chronic obstructive pulmonary disease (COPD); and 166,654 with type 2 diabetes mellitus (DM). According to RAND, improving coordination of care for patients with these 3 illnesses could save Medicare $1.5 billion each year.

The study used hospitalizations, emergency department visits, complications, and costs of care associated with the Bice-Boxerman continuity of care index. The researchers deemed care to be better coordinated if patients saw fewer health providers or if visits were concentrated among fewer providers, according to RAND.

Patients with better continuity of care were less likely to be hospitalized, less likely to visit emergency departments, had lower rates of complications, and had lower costs overall for their care.

“Our results suggest the potential importance of care continuity and underscore the potential benefits that can be achieved through programs that improve coordination,” Hussey said. “As health care delivery and payment programs evolve, we need to measure whether these reforms improve continuity and reduce health care costs.”

The Aetna Foundation and the National Cancer Institute provided support for the study.