Our
Services
Cost-Effectiveness Based Care Management
Clearing The
Bar of Cost-Effectiveness
Don’t Expect Cost Savings from Most Programs
The latest studies continue to demonstrate that most disease management and care
coordination programs may improve selected quality of care measures but do not
provide short-term savings.1,2 Cost-effectiveness
research confirms these results, showing that less than 20 percent of all prevention
and treatment activities are cost-saving.3
Cost-Effectiveness Analysis Is Necessary To
Determine Cost Savings
CareScientific uses the science of cost-effectiveness analysis to
determine the real net savings opportunity
by looking at the full costs and benefits of each intervention based
on evidence from randomized clinical trials and epidemiological data.
Using cost-effectiveness assessment, CareScientific can accurately
distinguish between those activities that, while clinically appropriate,
do not save money and those that provide real cost savings.
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Care
Management with an Emphasis on Medication Use
Medications Are Key To Cost Savings, But Only
When Targeted Correctly
Cost-effectiveness analysis shows that initiation and adherence to
pharmaceutical therapy for selected patients and medications is one
of the greatest opportunities for short-term savings for chronic
conditions. However, increasing compliance for some patients only
increases drug costs without the commensurate decrease in medical
costs. To select only the patients with real net saving opportunities,
CareScientific developed Cost-Effectiveness Filtering™,
a proprietary algorithm based on an extensive quantitative review
of control-group cost-effectiveness assessments that identifies only
the patient and health behaviors that can yield real cost savings.
Savings Are Quantifiable and Incremental to Existing Programs
Reason being, disease management programs do not sufficiently focus on or,
as evidenced by the latest research, improve medication compliance.4
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Real Savings You Can Verify
The determination of actual savings from care management
programs can be challenging due to the various secular trends that
can cause cost changes and the potential for regression to the mean.
CareScientific takes the most rigorous approach to establishing a
causal link between our program and outcomes based on the following
evaluation components:
- Use of a comparison group consisting
of similarly diseased members who are not eligible for the program—
to control for other factors that could cause the change
- Plausibility assessment that looks for changes
in the expected direction and amount for various intermediate
outcomes and cost components—to provide confidence that the savings
are due to the program
- Transparency in savings opportunity,
methodology and outcomes -- to provide plan sponsors the ability
to verify the results
Accordingly, CareScientific is advancing new
standards for outcomes measurement and reporting through rigorous,
control-group methodology, plausibility assessment, and transparency
to provide outcomes that are accurate and verifiable.
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Custom
Program Evaluation
CareScientific’s researchers each have over a
decade of experience in healthcare program evaluation, having conducted
more than 100 custom analyses and receiving several
research awards from scientific and professional organizations. We conduct independent
and rigorous assessments of disease management (DM), wellness programs,
value-based insurance design (VBID), and medication therapy management
(MTM).
Using comprehensive plan data and proven evaluation methodologies,
CareScientific helps plan sponsors determine the real outcomes
from their healthcare programs, including:
- Financial outcomes, including ROI
- Clinical outcomes
- Humanistic outcomes, such as quality-of-life
- Member satisfaction and provider satisfaction
- Processes of care and other leading indicators
that are necessary steps to outcomes improvement
Frequently, CareScientific employs comparison groups
to determine what outcomes improvements are due to the program rather
than to other market trends. We also conduct plausibility assessments
of programs to determine whether the vendor-claimed ROI is plausible
given the nexus of changes in outcomes and leading indicators.
See the Awards and
Research section for examples of CareScientific’s previous
evaluations.
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References
1Mattke S. et al. Impact of 2 Employer Sponsored Population
Health Managed Programs on Medical Costs and Utilization. American
Journal of Managed Care. February 2009.
2Piekes D. et al. Effects of Care Coordination on Hospitalization,
Quality of Care, and Health Care Expenditures Among Medicare Beneficiaries:
15 Randomized Trials. JAMA. February 2009.
3Cohen JT, Neumann PJ, and Weinstein MC. Does Preventive
Care Save Money? Health Economics and the Presidential Candidates.
New England Journal of Medicine. February, 2008.
4Chan V and Cooke C. Pharmacotherapy After Myocardial
Infarction. Disease Management Versus Usual Care. American
Journal of Managed Care. June 2008.