The effect of case management on the costs of health care for enrollees in Medicare Plus Choice plans: a randomized trial.
OBJECTIVE
To measure the effects of case management on an older population's costs of health care.


METHODS
A 1-year randomized controlled trial.


METHODS
Multiple sites of care in San Francisco, California.


METHODS
Patients aged 65 or older of primary care physicians in a large provider organization bearing financial risk for their care (n = 6409).


METHODS
Screening for high risk and provision of social work-based case management.


METHODS
Volume and cost of hospital, physician, case management, and other health-related services.


RESULTS
The experimental group used more case management services than the control group (0.09 vs. 0.02 months per person, P<.001). The experimental group's average total payments for health care were slightly lower ($3148 vs $3277, P = .40).


CONCLUSIONS
This study provides no statistically significant evidence that social work-oriented case management reduces the use or the cost of health care for high-risk older people. Other potentially favorable effects of this type of case management need to be evaluated, as do the effects of other types of case management.
Boult
C
C
Department of Family Practice and Community Health, University of Minnesota Medical School, Minneapolis, USA.
Rassen
J
J
Rassen
A
A
Moore
R J
RJ
Robison
S
S
D000368:Aged; D019090:Case Management / Q000191:economics* / Q000458:organization & administration; D003363:Cost Control; D005260:Female; D015577:Geriatric Assessment; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006302:Health Services Research; D006699:Home Care Services / Q000458:organization & administration*; D006801:Humans; D008297:Male; D020398:Medicare Part C / Q000458:organization & administration*; D020380:Needs Assessment / Q000458:organization & administration; D015397:Program Evaluation; D012017:Referral and Consultation; D012307:Risk Factors; D012495:San Francisco; D012947:Social Work / Q000458:organization & administration*; D011795:Surveys and Questionnaires; D014481:United States