MGH Hotline 2.13.09 At hospitals across the country, the sickest 15 percent of Medicare patients account for 75 percent of health care costs. This medically complex patient population often experiences poor health outcomes and requires repeated hospitalizations and trips to the emergency room.

Mass General Care Management Program receives extension

13/Feb/2009

At hospitals across the country, the sickest 15 percent of Medicare patients account for 75 percent of health care costs. This medically complex patient population often experiences poor health outcomes and requires repeated hospitalizations and trips to the emergency room.

In 2006, the MGH proposed to the Centers for Medicare and Medicaid Services (CMS) an innovative concept for a program aimed at improving the care and quality of life of the sickest of Medicare patients while reducing costs. CMS selected the MGH Care Management Program as one of six demonstration projects to better care for the Medicare patient population. Two and a half years into the program, the MGH's concept appears to be successful. The hospital recently received word that, because of its preliminary success, the program has been granted an extension to continue for another three years.

Directed by Eric Weil, MD, and managed by a multidisciplinary team of health care providers, the MGH Care Management Program incorporates use of a nurse care manager who is assigned to each patient. Serving as a point of access to care, the nurse care manager works closely with the patient, primary care physician and care team to coordinate services such as diagnostic tests, psychiatric and social services, and specialist appointments. Initial reports indicate that the program not only covers its costs but also may achieve cost savings. During a one-year period, data show a decline in emergency room admissions, inpatient admissions, and 15- and 30-day readmissons.

"We have received very positive feedback about the program from patients, their families and physicians," says Weil. "Ultimately, we hope that this program will serve as a national model that can be replicated anywhere in the country to bring streamlined and cohesive care to those who most need it."