What is the Business Case for Improving Care for Patients with Complex Conditions?

Abstract

INTRODUCTION Patients with complex conditions account for a disproportionate share of health care spending. Although evidence indicates that care for these patients could be provided more efficiently, the financial impact of mechanisms to improve the care they receive is unclear. DESIGN/METHODS Numerous mechanisms—emphasizing patient self-management, care coordination, and evidence-based guidelines—aim to improve the quality of care and outcomes for patients with complex conditions. Assessing the overall “business case” for these mechanisms requires carefully estimating all relevant costs and financial benefits, then comparing them in present value terms. Mechanisms that are not cost-saving may still be implemented if they are cost-effective. We reviewed articles in peer-reviewed journals, as well as reports available on publicly accessible websites, which contained data about the business case for mechanisms to improve care for patients with complex conditions. MAIN RESULTS Published studies do not provide clear evidence that current mechanisms are cost saving. This literature also has several major methodological shortcomings with respect to providing an understanding of the business case for these mechanisms. CONCLUSIONS Further research using standardized methodologies is needed to understand the business case for mechanisms to improve care for patients with complex conditions. Implications for VA business case analyses include the necessity of establishing appropriate time horizons, scope of services, and target populations, as well as considering the impact of existing VA systems.

Depression and Risk of Hospitalizations for Ambulatory Care-Sensitive Conditions in Patients with Diabetes

“…45 The increasing healthcare costs due to potentially preventable hospitalizations in older adults with diabetes have led healthcare systems to identify ways to predict patients at risk for greater costs. 46,47 Our models found that probable major depression, increased age, greater medical comorbidity and severity of diabetes complications, as well as lack of exercise, all had potent independent associations with ACSC-related hospitalizations, suggesting that these factors could comprise key elements of a prediction model to identify older patients with diabetes at risk for higher healthcare costs that could be validated in additional at-risk populations.…”

Multi-Morbidity in Hospitalised Older Patients: Who Are the Complex Elderly?

“…Although the complex elderly label is deemed inappropriate by some (personal communication, British Geriatrics Society, 2012), it is a term widely used in medical research and health literature, but so far there is no consensus on a definition, empirical or otherwise. Past attempts to define the “complex patient” have incorporated parameters such as the overall cost of care, the need for multiple interventions (referrals), and/or complexity of clinical profile [ 8 – 10 ]. In the past, the complex elderly term has been used by health organisations to establish charging costs for this particular group of patients who are known to consume considerable hospital financial resources.…”

“…More recently, patient complexity assessment has progressed towards the inclusion of psychological, socioeconomic, cultural, environmental, behavioural as well as biological factors [ 11 – 13 ]. For this purpose, the Interdisciplinary Medicine Instrument (INTERMED) tool was introduced to quantify the complexity of care needed by hospitalised patients incorporating factors such as diagnostics chronicity, mental health, social vulnerability and care coordination [ 8 , 13 ].…”

Greater Adherence To Diabetes Drugs Is Linked To Less Hospital Use And Could Save Nearly $5 Billion Annually

“…1 In addition, the quality of care for patients with chronic illness is suboptimal and often leads to poor outcomes, while costsaving quality improvements have been elusive. [2][3][4] In this context, it is particularly important to identify areas on which provider organizations might focus to simultaneously lower costs and improve care for patients with chronic diseases.…”