The most effective way to hold down medical bills may be to improve support for patients who are returning home from the hospital, researchers write in a new review of care management programs.

Thomas Bodenheimer and Rachel Berry-Millett prepared the “synthesis project” report for the Robert Wood Johnson Foundation, Princeton, N.J.

Bodenheimer and Berry-Millett focus mainly on reducing the cost of caring for people with a high number of chronic conditions.

Average per-person spending for a patient with 5 or more chronic conditions is $16,819 per year, compared with an average of just $994 per year for a patient with no chronic conditions, and the cost of caring for the growing number of older patients with 5 or more chronic conditions threatens the viability of Medicare, the researchers write.

Many studies have found that efforts to manage the care of patients going home from the hospital have improved quality and reduced hospital use and costs, the researchers write.

Studies have found no evidence that efforts to manage the cost of home care have improved the quality of care for home-bound patients or reduced the cost of their care, the researchers write.

Some primary care groups have tried to take responsibility for active care management efforts: 7 out of 9 studies found those programs improved quality, but only 3 of 8 studies that looked at participating patients’ hospital use found that the programs reduced participants’ hospital use.

“Though primary care is a logical site for care management, stresses on primary care make it difficult to implement effective care management,” the researchers write. “Even patients with health insurance are experiencing great difficulty gaining access to primary care when they need it. Current primary care physician visit lengths are not sufficient to handle the multiple problems of complex patients.”