Coordinated care programs designed to keep Medicare beneficiaries out of the hospital and reduce costs mostly did not work, according to a study published on Wednesday in the Journal of the American Medical Association, the AP/Washington Times reports. CMS selected 15 proposals for coordinated care test-site programs in 2002, and 18,309 total fee-for-service Medicare beneficiaries were enrolled in the programs. Most of the beneficiaries had age-related chronic conditions such as diabetes, heart disease and lung disease, and many had more than one chronic condition. The programs were intended to keep costs down while reducing hospitalizations. However, only two of the sites met this goal. The AP/Times reports, "The disappointing results show how tough it is to manage older patients with chronic diseases, who often take multiple prescriptions, see many doctors and sometimes get conflicting medical advice."

Study author Randall Brown -- a researcher at Mathematica Policy Research, which was hired to analyze the programs -- wrote that the results were "underwhelming." The "only way you can really do it is by changing patients' behavior and by changing physicians' behavior, and both things are really hard to do," he said. Although many of the beneficiaries would have benefited from lifestyle changes such as stopping smoking, losing weight, exercising more or eating healthier, such changes are especially hard to achieve in elderly patients, the AP/Times reports. Brown said, "The same thing with physicians," adding, "A lot of them feel like they know how to take care of patients, so why do they need a nurse calling up and asking them why the patient isn't on some certain medication?" (Tanner, AP/Washington Times, 2/11).

He also said, "If you want to save money, you need to focus your efforts on those people at highest risk" because patients with less severe conditions may benefit from care coordination, but costs are likely to outweigh the benefits in such cases. "That doesn't mean, 'Don't do something for the other patients,' but maybe not something as intense and expensive" (Goldstein, Philadelphia Inquirer, 2/11). An editorial accompanying the study in JAMA called the results "sobering" (AP/Washington Times, 2/11).

The study is available online. An extract from the editorial also is available online.

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