Studies conducted by Blue Shield of California and Kaiser Permanente have shown that their respective home-based care coordination programs have delivered a clear return on investment.
As both health plans gear up for program expansion and further studies supporting return on investment, other payers are exploring the adoption of similar programs.
BSC is talking to other health plans in the state, said Andrew Halpert, senior medical director. He said care coordination is now being viewed in the context of consumer-directed healthcare and as a strategy to "wring out" healthcare costs.
Frequent proactive phone calls and home visits can educate and empower patients to take care of symptoms related to their illnesses, thereby reducing unnecessary hospitalizations. "This is a huge benefit from a financial point of view," Halpert said.
After the success of BSC's pilot program, the health plan expanded the program to the rest of its commercial population in January 2005. In November 2006, it expanded the program to its Medicare population.
BSC hopes to test its hypothesis that the program would reap greater benefits, given the number of Medicare patients and their co-morbidities.
"We've been doing the right thing by the patient, and now we're back up with the business case," he said.
Kaiser Permanente conducted two studies on home-based palliative care that showed significant decreases in cost through reduced inpatient days. The first study was published in the Journal of Palliative Medicine in October 2003.
"In both studies, the palliative care patients received a higher number of home visits by an interdisciplinary team of providers, including physician home visits, than the control groups," said Kristine Hillary, regional director of Home Care Services for Kaiser Permanente's Southern California region.
Kaiser Permanente expanded its program to the rest of its service areas in Southern California after finishing its second study in 2005. Last year, more than 1,000 patients participated in the program. "The program is continuing to grow because the need is there to support Kaiser members with advanced chronic illness," Hillary said.
Michael Burcham, president of ParadigmHealth, a disease management company, said he expects significant investment in monitoring services in the home, either direct, intensive support or virtual technology-based assistance. "There are innovative ways to create a safe home environment and a strong network of support using clinical expertise and technology," he said.