In terms of healthcare for some of the nation’s sickest, more can ultimately cost less, a new study shows. Researchers at the Johns Hopkins University Bloomberg School of Public Health found that a comprehensive primary care approach for older people with chronic illnesses reduces medical costs later on. The research, published in the American Journal of Managed Care, found that patients in a so-called “Guided Care” program spent less time in hospitals and skilled nursing facilities and had fewer emergency room visits and home-health episodes.

 

Under the Guided Care model, a team of two to five physicians, a registered nurse, and other staff members offer comprehensive care to aging chronic patients in a medical home.

 

During an eight-month randomized controlled trial, the researchers found that patients in Guided Care spent less time in hospitals and skilled nursing facilities and had fewer emergency room visits and home health episodes.

 

“Guided Care patients cost health insurers 11 percent less than patients in the control group,” say Chad Boult, the principal investigator of the study and creator of the Guided Care model. “If you apply that rate of savings to the 11 million eligible Medicare beneficiaries, programs like Guided Care could save Medicare more than $15 billion every year,” adds Boult, who is a professor in health care policy at the Bloomberg School and director of the Lipitz Center for Integrated Health Care.

 

Compared to patients who received usual care, Guided Care patients experienced, on average, 24 percent fewer hospital days, 37 percent fewer skilled nursing facility days, 15 percent fewer emergency department visits, and 29 percent fewer home health care episodes, according to the study.

 

“While Guided Care patients received more personal attention from their care team and had more physician office visits, the avoided expenses related to care in hospitals, skilled nursing facilities and emergency departments more than offset all the costs of providing Guided Care,” says lead author Bruce Leff, associate professor in the Bloomberg School's department of health policy and ,management and associate professor in the department of medicine at the Johns Hopkins School of Medicine. “The program realized annual net savings of $75,000 per nurse, two-thirds of which resulted from reductions in hospitalization.”

 

Other studies have shown that Guided Care improves the quality of patients' care, reduces family caregiver strain, and improves physicians' satisfaction with chronic care, the researchers add.