ABSTRACT
Purpose and Objectives: The management of chronic medical conditions is very costly because of poor response to evidence-based treatment plans. Behavioral health disorders have been shown to impact one's inability to adhere to treatment protocols, thus worsening the course of the comorbid state. Traditional management methods have been unsuccessful in diminishing the costs associated with increased utilization of healthcare services that result from poor adherence to treatment plans and treatment failures that ultimately produce poor clinical outcomes. This article examines the use of an alternative approach on an identified high-risk population of individuals with the primary goal of promoting patient-centric self-efficacy and optimal patient care, thereby improving clinical outcomes resulting in a reduction of overall healthcare utilization.
Primary Practice Setting: Care coaches, in collaboration with primary care physicians, engaged in telephonic consultation with identified participants from one regional health plan to validate and modify treatment plans in order to conform to evidence-based guidelines.
Findings/Conclusions: The approach used in this study demonstrated improved clinical outcomes through decreases in acute care facility admissions, lengths of stay in acute care facilities, and emergency department visits. In addition, a positive return on investment is presented as evidence of the efficacy of this alternative approach.
Implications for Case Management Practice: Predictive modeling and risk stratification methodologies are useful in the identification of individuals at risk for treatment failure and poor outcomes. Individuals who suffer from multiple comorbidities with identified psychosocial issues/barriers have increased health risks and costs that are far greater than those who do not appear to have associated psychopathology or psychosocial factors. Examining the use of the study protocol from a lifetime perspective can further reduce costs in the future and still show a positive return on investment.