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Care Coaching Shown to Improve Outcomes for Patients Suffering from Both Behavioral and Physical Health Conditions, Reducing Costs for Health Plans

Wednesday, June 9, 2010 Health Insurance News J E 4
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BUFFALO, N.Y. and TAMPA, Fla., June 8 Health plans with members suffering from both physical and behavioral health conditions can reduce medical expenses attributed to hospital admissions, lengths of stay and emergency room visits while improving health outcomes for their members with the use of "Care Coaching," according to a peer-reviewed study from Health Integrated and HealthNow New York. The study, published in the current issue of Professional Case Management (May/June 2010), also found that Care Coaching - consultation with licensed mental health counselors and registered nurses with experience in psychopathology and behavior modification - resulted in a positive net return on investment of 3.84 for the health plan during the one-year time period reviewed.

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Authors of "Care Coaching: An Alternative Approach to Managing Co-Morbid Depression" examined the use of Care Coaching for an identified high-risk population with the goal of assessing how Care Coaching contributed to optimal patient care to improve clinical outcomes and reduce healthcare utilization. In the study, Care Coaches worked with members and supervising Health Integrated medical directors who, in turn, consulted with members' primary care physicians to validate or modify treatment plans in accordance with evidence-based guidelines.

"The numbers support what we already know - that addressing behavioral health conditions along with medical symptoms is extremely effective at improving member health while also reducing costs," says Sam Toney, vice chairman and chief medical officer of Health Integrated and one of the study's authors. "No matter what the behavioral health condition or psychosocial issue - whether it is depression, substance abuse or maladaptive behavioral patterns - looking at the 'whole patient' leads to innovative and integrated approaches to managing psychosocial barriers along with physical conditions."

During the course of the year-long study, 3,305 members of a regional HealthNow New York health plan were assigned to dedicated Care Coaches, who fostered collaborative relationships with the members' attending primary care physicians. Once enrolled, members were screened for behavioral health conditions as well as psychosocial issues such as anxiety, affective disorders and chemical dependency alone, or as co-morbidities to other medical conditions. All of these conditions can have a significant negative effect on total healthcare costs, according to Dr. Toney. The Care Coaches helped members establish individual goals that included taking medication appropriately, following their doctors' treatment plans, losing weight and appropriate physical activity.

Over the 12-month review period, researchers identified and evaluated three key measures with results reported on a per thousand basis:

When associating these results with claims data during the review period, researchers found there were considerable costs savings to the health plan as compared with claims costs from the base period. The program had a positive net ROI of 3.84 during the time period reviewed and for which data are available.

"Most patients treated for chronic conditions, such as depression, are seen by doctors who don't specialize in mental health," says Karen Blount, vice president of health care services, HealthNow, NY. "This program, which focuses on supporting primary care physicians while empowering members to better self-care, has now been proven, with validation of results, to drive successful outcomes."

Authors of the study were Jay Pomerantz, MD, former chief medical officer and senior vice president of HealthNow New York; Dr. Toney and Zoe Hill, PhD, director of clinical research, Health Integrated. To download a copy of the paper, which includes a case study example of the effectiveness of Care Coaching, go to http://healthintegrated.com/web/study-pcm/.

About HealthNow New York

HealthNow New York, one of New York State's leading health care companies, provides a full spectrum of health care products, solutions and funding arrangements to companies and individuals located throughout the United States. Headquartered in Buffalo, NY, HealthNow does business as BlueCross BlueShield of Western New York, BlueShield of Northeastern New York, HealthNow New York, and Brokerage Concepts Inc. In 2009, company revenues grew to nearly $2.45 billion.

About Health Integrated

Health Integrated is the leading innovation partner for health plans, providing evidence-based solutions to accelerate achievement of health management goals for clinical outcomes, quality measures and cost containment. For more information, visit www.healthintegrated.com.

1. Acute care facility admissions, which were reduced from 44.91 to 23.66; 2. Average length of stay measured in hospital days, which were reduced from 276.15 days to 146.59 days; and, 3. Visits to the emergency departments, which were reduced from 71.90 to 53.05.

SOURCE Health Integrated
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