How effective is telephonic case management of patients with cancer?

Abstract

254 Background: Case management offers the opportunity to improve quality of cancer care but the financial impact is largely unknown. Optum’s Cancer Support Program (CSP) provides patients and their caregivers with telephonic case management services which are focused on reducing emergency department visits and hospitalizations, and helping patients comply with treatments and more effectively manage symptoms related to their disease or to its treatment. This study evaluates the effectiveness of CSP primarily from financial perspectives. Methods: The study used a case control approach to compare participants and non-participants of the Optum CSP program. The propensity score method was applied to adjust for baseline differences between the two groups. The study population consisted of cancer patients (N=8,833) enrolled in commercial health plans through self-insured employers. The patients were referred to CSP between July 2009 and June 2011. Analyses were conducted for survivors and decedents separately to account for mortality bias. Outcomes of cost and hospice days were estimated with generalized linear models. Results: For program participants who were under active treatment and survived at least 6 months after referral, cancer-related medical cost per patient per month during the six months of follow up was reduced by 9.8% (95% confidence interval [3.7%, 15.6%], p-value 0.002), and almost 60% of the cost savings were from inpatient admissions. The decedent’s cost during the last 3 months of the life was reduced by 19.9% (95% confidence interval [2.8%, 34.1%], p-value 0.025), and more than 80% of the cost savings were from inpatient admissions. The average hospice days of all deceased CSP participants increased by 42.3%, (95% confidence interval [13.9%, 77.8%], p-value 0.002). Conclusions: We conclude the Optum CSP program is effective in reducing medical cost among both cancer survivors under active treatment and those who did not survive, while promoting hospice utilization during end-of-life.