Managing high-risk patients: the Mass General care management programme.

Area of Science:

• Health Services Research
• Healthcare Management
• Public Health Policy

Background:

• High-cost Medicare fee-for-service (FFS) beneficiaries, often elderly with multiple chronic conditions, present significant healthcare challenges.
• Intensive, practice-based care management models are being explored to improve outcomes and reduce costs in this population.
• The Massachusetts General Care Management Program (CMP) was established as a federally supported demonstration project.

Purpose of the Study:

• To evaluate the impact of intensive, practice-based care management on high-cost Medicare FFS beneficiaries.
• To assess the cost-effectiveness and impact on hospital readmissions of the CMP.
• To determine the feasibility of implementing care coordination within existing healthcare structures.

Main Methods:

• The CMP operated for six years in two phases, initially at Massachusetts General Hospital and later expanding to affiliated sites.
• The program focused on individuals meeting specific eligibility criteria, providing integrated care managed by a case manager embedded in primary care.
• Modifications were introduced, particularly for managing transitions to post-acute care in skilled nursing facilities.

Main Results:

• The demonstration project achieved substantial cost savings compared to traditional Medicare FFS.
• No significant impact was observed on hospital readmission rates.
• The CMP was successfully implemented within an existing healthcare organization without fundamental structural changes.

Conclusions:

• Intensive, practice-based care management can lead to significant cost savings for high-cost Medicare beneficiaries.
• The CMP model offers a scalable approach to care coordination that can be integrated into existing healthcare systems.
• While cost savings were achieved, further strategies may be needed to address hospital readmissions.