Well-designed programs to coordinate care for patients with complex needs can reduce Medicare expenditures, including skilled nursing facility costs, according to an issue brief released Thursday by The Commonwealth Fund.

Health Quality Partners in Pennsylvania achieved a 64% reduction in skilled nursing facility costs through one such program, according to figures cited in the report.

The investigators focused on 18 successful complex care management programs associated with accountable care organizations. Many ACOs and other healthcare systems have implemented these types of programs in an effort to manage care for “high-need, high-cost” patients in a more efficient way, the authors noted. However, they have achieved mixed results in terms of cost savings. By focusing on high-performing programs, the investigators identified best practices.

While there are various types of CCMs, the authors focused on “specially trained, multidisciplinary care teams.” These teams work with providers across the continuum to ensure people with advanced illness or multiple chronic conditions have their needs met through integrated care.

In successful programs, these CCM teams consider care coordination a primary responsibility, according to the findings. To identify gaps in the care continuum and see that patients can receive services in the most appropriate setting, the teams should build relationships with skilled nursing facilities and other community providers as well as hospitals and primary care physicians, the authors stated. The CCM teams also “need to develop protocols for end-of-life services,” including advance directives and palliative care.

Building trusting relationships with patients, using technology smartly, doing specialized training for CCM team members, and customizing the approach to “local contexts and caseloads” were other best practices identified.

The Medicare fee-for-service reimbursement approach is the primary obstacle to broader adoption of CCM initiatives, the investigators argued in a New England Journal of Medicine Perspective article on their findings. Alternate payment models, such as those offering lump sums to cover all the services needed by these complex patients, might be better, they wrote.