Evidence Database Review in Medical Reference Services Quarterly, 2009
Citation

FOR IMMEDIATE RELEASE: August 4, 2009

Contact: Jeannine Melly, (212) 822-7346; jmelly@nyam.org
                 Lisa Chen, (212) 584-5000; lchen@fenton.com
For a copy of the report, visit: www.socialworkleadership.org

New Report Points to Care Coordination for Older Americans as a Critical Solution to Lowering Health Care Costs, Reducing Hospitals Readmissions

As Congress Debates Healthcare Reform, Researchers Identify Care Coordination as Key to Reducing $17.4 Billion Annually in "Revolving Door" Treatment for Medicare Patients

NEW YORK, NY— As the debate intensifies around the cost of national healthcare reform, a new report has identified financing and payment strategies for effective care coordination. Healthcare experts have pointed to care coordination as a potential solution for reducing hospitalization, particularly re-admissions for Medicare patients with multiple chronic conditions, which account for a significant portion of the nation's healthcare costs.

The report, "Structuring, Financing, and Paying for Effective Chronic Care Coordination," examines various organizational approaches that provide effective care coordination and explores financing and payment options for these models.

"We've known that care coordination works for older Americans and their caregivers. This report answers the question of how to pay for it, and on a scale large enough to benefit the millions of Americans who need it," said Robyn L. Golden, LCSW, Director of Older Adult Programs at Rush University Medical Center and Co-Chair of the National Coalition on Care Coordination (N3C), which commissioned the report. "Now all we need is the political will."

Key findings from the report include:

• 'One size does not fit all': Different care coordination models are more effective for populations with different chronic conditions or functional limitations and must be carefully targeted to achieve the best care and cost results.
• Current fee-for-service payment is inherently limited for supporting care coordination and does not offer incentives for effective performance. Instead, a "Per Person Per Month" (PPPM) fee approach can be scaled to the care coordination model, risk-adjusted for patient complexity, and provide incentives based on the quality of care, the patient's experience, and health spending for a defined population of patients. This approach can be used in addition to, or in place of, fee-for-service.
• Medical care must be linked to social support services to improve or stabilize the condition of many older patients. Older adults and their caregivers must also be actively engaged for care coordination to be successful.
• Medicare and Medicaid funding sources should be integrated to address the care coordination needs of the 'dual-eligible' population with multiple chronic conditions and/or functional impairments.

Care coordination is "a key approach for improving quality while controlling costs," according to the report's authors, Robert Berenson, MD, an Institute Fellow at the Urban Institute and an expert in Medicare policy, and Julianne Howell, PhD, an independent technical consultant to The New York Academy of Medicine's (NYAM) Social Work Leadership Institute and the Centers for Medicare & Medicaid Services (CMS).

According to the report, "The inclusion of various [care coordination] models in the policy documents and draft legislation thus far released from both the House and Senate Committees developing health reform legislation is a testament to the extent of interest in, and hope for, the potential that care coordination could offer in addressing the limitations of the current delivery system in effectively managing the ever-increasing chronic disease burden in the U. S. population."

"We're urging our leaders in Congress to pay close attention to these report findings as they hammer out reforms aimed at improving healthcare quality and making it more affordable for all Americans," said Jeannine Melly, Acting Director of NYAM's Social Work Leadership Institute, a co-founder with the American Society of Aging of N3C. "As more and more Baby Boomers age, demand for care coordination will only escalate. Now is the time to lay the groundwork to make it accessible to everyone who needs it."

"As Congress considers all avenues that may reduce the cost and improve the quality of our healthcare system, the National Coalition on Care Coordination's report provides evidence that appropriate care coordination can both reduce the burden of duplicative services and payments and improve the care of patients with complex needs," said Jo Ivey Boufford, MD, President of NYAM.

About The National Coalition on Care Coordination
N3C was formed in 2008 with support from The Atlantic Philanthropies to promote better-coordinated health and social services for older adults with multiple chronic conditions and to make care coordination an essential part of health care reform. Members include leading experts from aging, social, healthcare, family caregiver and professional organizations.