A really interesting story in today’s New York Times about an attempt to use what seems to be a flavor of RM to bring Medicare costs down.
The story concerns a program called the Medicare Health Support program. Eight companies participated in the test, which affected roughly 160,000 patients. According to the Times, the program simply involved having teams of nurses maintain telephone contact with patients to insure that they are taking the right medications, and seeing their doctors.
It’s unclear at this juncture whether or not the program actually creates cost savings, but prelimiary data doesn’t look promising. The story says "Experts say that Medicare and the companies alike were too optimistic about how easy it would be to prevent costly complications and hospital visits by patients who are very sick." The participating companies claim that Medicare has hindered their ability to delivery results by enrolling patients who were far sicker than initially planned, and by failing to provide timely information about lab results , the use of prescription drugs, and so on.
A couple of thoughts. First, this isn’t really RM, although it mimics some of RM’s characteristics. It is, rather, a kind of medical outreach program, targeted at extremely sick patients — people suffering from serious cases of diabetes and congestive heart failure, for example.
Second, compared to the costs of an RM program, having nurses, as in this trial program, personally contact individual patients, is enormously expensive. The RM toolkit typically contains much less expensive, yet effective, contact methodologies — online, direct mail and so on. Direct one-to-one contact strategies are an entirely different matter.
Interestingly, though, the Times story did vividly demonstrate the enormous need for patient information. One nurse, Jill Coker, who made 25 to 30 calls per day, told the times that most of her time was spent on "rudimentary issues, like explaining to patients what prescription drugs they are on and helping them devise ways to make sure they remember to take their medicine." She is quoted as telling the reporter that "There have been numerous diabetics who didn’t even know what an endocrinologist was."
That should make anyone stop and think for a second. These are very sick patients, whose lives depend on being on top of the management of their conditions. Congestive heart failure is a very serious ailment. Yet, despite this, as Ms. Coker and her fellow nurses demonstrate, there is a widespread, pervasive lack of knowledge about how to best manage this illness.
And if there’s such a dearth of information for heart failure, one can only imagine the situation for patients with less severe chronic conditions, or those which are asymptomatic — hypertension for example.
There’s no real question that improved adherence and better outcomes are the result of true communication with patients, and the delivery of information and service. What this pilot program may demonstrate, though, is that a marketing approach rather than a healthcare approach may be the way to go about it.