Care Management Is Not Enough

The Camden Core Model is one of the best studied care coordination models aimed at reducing hospitalizations and improving patient outcomes and is being used as a model for other super-utilizer programs. However, rigorous scientific investigations have yielded disappointing results. Over four years, intensive care management interventions for high-risk, complex care patients immediately post-discharge have increased ambulatory care for both primary care and specialist visits, however hospitalizations and patient outcomes remain unaffected. Even in “failure” there are valuable lessons to be learned. 

Let’s look at the details. The Camden Care Model calls for 90-days of care coordination provided by an interdisciplinary team in the home setting for high-risk Medicaid patients who had been discharged from a hospital admission to the community. Those who received this intervention did increase their likelihood of receiving ambulatory care within 2 weeks post-discharge from 27% to 42%, and those receiving ambulatory care within a year rose from 73% to 82%. The likelihood of receiving durable medical equipment also increased. However, the number of emergency department visits and prescription medications was unaffected, as was the utilization of home-based care which remained at a very low 2%.

There are several possible interpretations of these outcomes. First, that implementation was not optimal, though separate studies of other medical care management programs have shown similar results. Another possibility is that not enough attention was given to nonclinical needs. While the Camden Core Model focuses on attending to medical needs and follow-up, not much intervention is provided regarding supplemental supports, especially in the areas of housing and legal services. This may be testament to the vital importance of attending to the social needs of patients outside of their clinical needs. Without addressing the social determinants of health, even high-powered medical care management will be insufficient to improve patient outcomes or to right-size care. Building meaningful networks with community-based social service agencies may be the missing link. Another possibility for the poor results could exist within the low utilization of home-based care. Focusing on bringing the loci of care to the home could be another avenue to explore. 

Source Material:

“The Camden Coalition Care Management Program Improved Intermediate Care Coordination: A Randomized Controlled Trial” by Finkelstein, A; Cantor, JC; Gubb, J; Koller, M; Truchil, A; Zhou, RA; and Doyle, J; published on December 20, 2023 by Health Affairs and available at https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2023.01151