Good ideas and dismal results

An oddly incoherent article. From These Patients Are Hard to Treat by Reed Abelson. The subheading is

A study examined a popular approach that coordinated care for the most expensive patients, and found that the project did not reduce hospital admissions.

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This idea was hot during the Obamacare debate.

In the quest to reduce health care spending in the United States, the idea held incredible promise: By addressing the medical and social needs of the most expensive patients, you could keep them out of the hospital.

These individuals, frequently struggling with addiction or homelessness, have extremely complicated medical conditions. By finding them and connecting them to the right doctors and social services, dozens of costly hospital stays could be avoided. The idea has been adopted in numerous communities around the country.

It was a hot idea despite an analog in education never having shown the desired results. In education it is often referred to as wrap-around services and is rolled out in order to try and address group differences in education scores. The idea behind wrap-around services is that kids can't learn if they are hungry, or tired, or have stressful home lives etc. It is appealing in its conceptual simplicity.

The proposition was that if you provided wrap-around services such as healthcare, parental coaching, psychological services, etc. through the school, services which mitigated all those negative environmental issues, you could close the gap. Those services are expensive and often difficult in practice to target to those most in need. But it was the simplistic concept of the moment and the gilded charlatans ran with it.

Lots of pilot projects, lots of money, lots of goodwill, lots of effort. And no results.

Which seems like what this article is reporting as well. It is awkwardly reported but the substance seems to be that they did a randomized control study of 800 high medical-use patients, 400 with the wrap around services and 400 treated in the traditional fashion.

In terms of outcomes, what they found was that both groups showed a fall in consumption of services. Basically, those who were high consumers in one time frame may not be high consumers over time. They revert to the mean. And both groups reverted to the mean at the same rate. Whether they received coordinate care made no difference.

Even failed studies are useful. One of the lessons the researchers learned was that the chaotic patients whom they sought to assist had far wider and deeper needs than they could have anticipated.

The prospect remains that if the study were repeated but even more generously funded with an even and ever broader array of free services to the targeted population, we might at some point see some measurable effectiveness.

But all failed experiments claim that the study was not done right and with more funding it could be done better and we would see results. Or not. I am guessing that this is one of those occasions where it ought to be studied again leveraging the lessons learned. But who wants to attach their professional reputation and five years of their professional life to a failed project? As long as the money flows, it happens but there is no denying that one failure can lead to an improved second effort but is more likely an indicator that the idea is without merit.