Reduced Mortality: The Unexpected Impact of a Telephone-Based Care Management Intervention for Older Adults in Managed Care

Abstract

Objective. This analysis evaluated mortality over 24 months for Medicare managed care members who participated in the Care Advocate Program (CA Program) designed to link those with high health care utilization to home-and community-based services. Data Source. Secondary data from the CA Program, part of the California HealthCare Foundation's Elders in Managed Care Initiative. Study Design. Randomized-control trial in which participants (N 5 781) were randomly assigned to intent-to-treat (ITT) and control groups. ITT group received telephonic social care management and 12 months of follow-up. Various multivariate analyses were used to evaluate mortality risk throughout multiple study periods controlling for sociodemographic characteristics, health status, and health care utilization. Population Studied. Older adults (651) enrolled in a Medicare managed care plan who had high health care utilization in the previous year. Principal Findings. ITT group had a significantly lower odds of mortality throughout the study (OR 5 0.55; p 5 .005) and during the care management intervention (OR 5 0.45; p 5 .006), whereas differential risk in the postintervention period was not statistically significant. Other significant predictors of mortality were age, gender, three chronic conditions (cancer, heart disease, and kidney disease), and emergency room utilization. Conclusions. Findings suggest that the care advocate model of social care management affected mortality while the program was in progress, but not after completion of the intervention phase. Key model elements accounted for the findings, which include individualized targeting, assessment, and monitoring; consumer choice, control, and participant self-management; and bridging medical and social service delivery systems through direct linkages and communication