The American health care system desperately needs a way to prevent complications of chronic disease that works. Aetna’s recent news of its 2-year experience offering HQP’s program to higher-risk Medicare Advantage members is the latest in a long line of evidence that HQP’s model of nurse care management works. [click here for Aetna’s press release] As compelling as the most recent Aetna data is (hospital admissions reduced 15%, outpatient services by 17%, and overall hospital expenditures 16%) it actually understates the effectiveness of the program – by a wide margin. Why?
Of the 1,200 higher-risk members HQP was authorized to serve, only 170 (14%) transitioned from the quality monitoring arm of the program into the advanced care management intervention – though many more could have benefited from the intensive intervention. The evaluation of the program was undertaken by comparing the outcomes of the full 1,200 member roster to outcomes among similar members not in the HQP program. A rigorous intention to treat, difference-in-differences approach to analysis. Had more members been enrolled into HQP’s intensive service, a greater overall cohort impact would have been realized – probably closer to the 25-39% reduction in hospitalizations seen with HQP’s program in the Medicare Coordinated Care Demonstration. [click here to see those data] The relatively low enrollment into the intensive arm of the HQP program had to do with remediable budgetary, structural, and operational constraints appropriate for a pilot phase of work – not a lack of member or physician interest in or satisfaction with the program. HQP and Aetna are now working together to build on our shared experience to make changes that will allow the model to be even more effective going forward.
There is an incredible amount of uncertainty as to whether and to what degree recent health care reform and innovation efforts are making a difference. Have the billions spent on Healthcare Information Technology (HIT), Big Data, Accountable Care Organizations (ACOs), Patient-Centered Medical Homes (PCMHs), and Bundled Payments (BPCI) improved the health of the nation and lowered the cost of health care? It’s hard to tell at this point. Maybe its too soon to know, and some of these efforts will yet yield better health and lower cost with more time and research. They are conceptually appealing and each have their constituencies, but to date – there is little compelling evidence that they work. They sure are BIG BETS though, involving lots of money and lots of uncertainty. By contrast, the HQP model of community-based nurse care management has a sustained record of effectiveness whether sponsored by CMS, provider organizations, or health plans.
To learn more about HQP and its programs and services visit our website at: http://hqp.org
There is an incredible amount of uncertainty as to whether and to what degree recent health care reform and innovation efforts are making a difference. Have the billions spent on Healthcare Information Technology (HIT), Big Data, Accountable Care Organizations (ACOs), Patient-Centered Medical Homes (PCMHs), and Bundled Payments (BPCI) improved the health of the nation and lowered the cost of health care? It’s hard to tell at this point. Maybe its too soon to know, and some of these efforts will yet yield better health and lower cost with more time and research. They are conceptually appealing and each have their constituencies, but to date – there is little compelling evidence that they work. They sure are BIG BETS though, involving lots of money and lots of uncertainty. By contrast, the HQP model of community-based nurse care management has a sustained record of effectiveness whether sponsored by CMS, provider organizations, or health plans.
To learn more about HQP and its programs and services visit our website at: http://hqp.org