Discussion
The economic evaluation of our new local, collaborative, stepped, and personalized LoChro care management program showed no significant difference in health care costs between participants who received the LoChro-Care and those who received usual care, regardless of whether health care costs were measured 12 or 18 months after the start of the intervention. Thus, we did not find evidence to support our hypothesis that LoChro-Care would be associated with savings in health care costs. This result suggests that the overall extent of health care utilization progressed similarly between the two groups, regardless of the type of intervention they received.In addition, our hypothesis - that LoChro-Care leads to more appropriate use of health and care services - was not supported. For the ten different cost indicators measured 12 and 18 months after the start of the intervention, we found no group differences. This means that participants who received LoChro-Care were not associated with the expected reduction in emergency hospital admissions, reduction in non-elective hospital days and nursing home admissions, more appropriate use of informal and formal community services, and improved ability to self-manage their condition, compared to participants who received usual care.Our analysis however showed that 3-month health care costs of LoChro-Care are highly correlated with the patients’ formal level of care. In Germany, a structured assessment of care needs, e.g. for activities of daily living, mobility or personal hygiene, is used to determine the level of care and thus the amount of financial support a patient receives from the statutory long term care insurance. This financial support was not included in the healthcare utilization costs assessed in this study because it is provided by the German long term care insurance rather than the health care insurance, on which our analysis focused. In addition, because reducing the need for nursing care is a lengthy process, we hypothesized that LoChro-Care would offer potential for short-term health care cost savings rather than impacting long-term costs.Direct comparison of the results with other studies offers a number of challenges. First, inclusion in the study occurred during a hospital contact. Secondly, inclusion in the study was based on a pre-assessment regarding the participants’ risk of unplanned readmission and need for nursing care. Nevertheless, the result of the LoChro study is in line with previous studies analyzing the costs of care among older patients in the outpatient sector [