Complex Care Support Model Reduces Utilization, Improves Quality of Life

A healthcare delivery model that utilizes home visits and that is interdisciplinary and team-based has been shown to improve care while controlling costs for patients with complex needs, according to a study published in PLOS One. While just 10% of patients are classified as complex care patients, they account for 64% of total healthcare costs. Complex care refers to patients with healthcare needs that are complicated by significant medical and psychosocial factors, such as multiple chronic conditions and comorbid physical and mental health conditions.

“There is growing evidence that complex care models that involve home-based assessments effectively reduce high cost health care utilization, such as readmissions and emergency use, while simultaneously improving patient quality of life, and will be extremely important ‘anchor programs’ for health care delivery systems in the current era of payment reform,” study author Gina Intinarelli, RN, PhD, MS, executive director of the University of California San Francisco Office of Population Health and Accountable Care, said in a statement. “This study provides confirmation of the benefits of these home-based assessments.

The study of 152 high-risk patients in 4 California medical clinics found the Care Support model resulted in a significant decline in healthcare utilization for both emergency department (ED) visits and hospitalizations when comparing utilization 6 months before versus 6 months after enrollment. Care Support was designed to be a support system between patients/caregivers and their primary care provider (PCP). The study examined the impact of Care Support’s implementation on healthcare utilization and patient quality of life (QOL) in 4 primary care medical clinics at a large urban academic medical center.

Patients defined as having at least 5 emergency department (ED) visits or at least 2 inpatient hospitalizations in the past 12 months were vetted by PCPs for appropriateness of enrollment in the Care Support program. For example, PCPs may have decided that Care Support was not needed by patients who were already well supported, who were associated with another team providing aggressive care management, or who were rapidly declining and unlikely to benefit. All enrolled patients received an individualized care plan created for them that was reviewed by the PCP.

The study, from Christine Ritchie, MD, MSPH, FACP, FAAHPM, and colleagues at the University of California San Francisco, concluded that it was feasible to implement Care Support at an academic medical center by making adaptations based on local needs.

“Care Support patients experienced significant reductions in acute care utilization and significant improvements in self-rated health,” the authors wrote.

Patients in Care Support also reported significantly better self-rated health over time. Enrollment in Care Support decreased acute care utilization and improved self-rated health in those who participated in the program compared with patients receiving usual care.

The patients who benefited most from Care Support were patients who had:

1. High, resource-intensive needs, multiple complex conditions, and poor care coordination
2. Little community support, especially those living alone, those who did not trust the medical system, or those who were resistant to care
3. Mild anxiety who were using the ED to address an array of symptom concerns

The factors that were key to the success of the Care Support program included the program’s protocols, which provided structured and adaptable templates that allowed the team to more efficiently manage patients with complex care needs; the home visit, which provided the team with key insights into the issues and needs of each patient in their own environment; the comprehensive assessment, which gave a complete picture of all of the patient’s needs, and the interdisciplinary team, which enabled incorporation of a wide range of perspectives.