Managed Care of Chronic Conditions Improves Outcomes, Saves Money

Patients with multiple diagnoses are usually hard to treat. Patients who suffer from diabetes and heart problems, couple with depression, are some of the most daunting patients for caregivers. These patients typically have more severe complications and higher mortality rates than patients who are not suffering from depression. These patients tend to have worse outcomes and higher healthcare costs than their non-depressed counterparts. This high cost of care costs the taxpayers billions each year in payouts to providers of their healthcare. Recent studies have shown that a team based approach to managing the healthcare of this population group can improve the health and compliance of treatment, saving the taxpayers millions a year.

One of the main reasons patients with depression coupled with other health problems are so hard to treat is that these depressed patients tend to have a higher incidence of risky behaviors. Depressed patients tend to have a higher incidence of tobacco and illicit drug usage. These patients also have a history of non-compliance with their medications for both their medical and behavioral conditions. Depressed patients also tend to be less physically active than their non-depressed counterparts. Depressed patients tend not to monitor their eating habits as well. All this adds up to a never ending cycle of visits to their healthcare provider often with ever worsening conditions. Coupled with all this is emerging evidence that depression releases hormones that can interfere with glucose control, increase heart rate and raise blood pressure.

Recent findings recently published in The New England Journal of Medicine show that a team managed approach to care of these patients can lead to better outcomes. The University of Washington and a Seattle based managed care group, Group Health Cooperative were the leads in this study. The study paired clients with specially trained nurses who coordinated the care of the patients involved. The nurses focused on optimization of the patient's management of their depression, high blood pressure, blood glucose and cholesterol. These specially trained nurse-coaches first monitored and helped adjust the patient's medications to achieve optimal benefits. The nurses also coached the patients in lifestyle changes that would provide benefits to their overall health. Nurses involved in the study reported dramatic improvements in their patients overall health.

The cost benefit is reported to be great. While a cost-benefit of the analysis is still being completed, the numbers look promising. The average cost of nurse coaching was about $1,200 for two years per participant while the average cost per year for patients with multiple chronic diseases is around $10,000 annually. A managed approach can cut this figure dramatically.

http://articles.latimes.com/2010/dec/30/health/la-he-depression-20101230

http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=21

http://www.webmd.com/depression/news/20101228/team-treatment-helps-depression-chronic-disease

http://www.nejm.org/doi/full/10.1056/NEJMoa1003955

http://www.physorg.com/news/2010-12-team-based-approach-success-depression-diabetes.html

http://www.ghc.org/