Yay or Nay: Does coordination of care work?

An interesting and somewhat shocking Wall Street Journal report cites research from the Journal of the American Medical Association that finds coordination of care is ineffective at containing health care costs.

The model generally involves nurses or other medical professionals serving as the linchpin between physicians, other service providers and patients -- with the belief that keeping everyone on the same page regarding patient care and education would result in lower costs from reducing duplicative efforts and reduced hospitalizations due to conflicting treatment regimens.

JAMA's study shows that in 15 random trials of care-coordination programs, only two -- yes, two -- showed significant differences in hospitalizations between those whose care was coordinated and a control group. Even worse, one of the two actually posted more hospitalizations. The dagger: none of the programs posted any savings.

Having devoted no small amount of ink in EBN to the effectiveness of the care coordination model, I was truly surprised to read this data. What about you? What is your view of care coordination? Is it effective -- yay or nay?

Tip of the Day: Cash is the biggest carrot

I'm not a scientist, and I could tell you that cash is king. If you want someone to do/not do something, paying them is a good way to get the desired result.

However, for you empirical types, actual scientists have collected data on the effectiveness of cash as an incentive -- specifically when getting employees to quit smoking.

A recent Wall Street Journal article reports a study published in the current issue of the New England Journal of Medicine found smokers who were paid to quit succeeded far more often than those who got no cash reward.

Tracking 878 smokers who lit up an average of a pack of cigarettes a day, one group received up to $750 to quit, spreading out payments to encourage them to stick with it. The poor control group got bupkus.

The nonsurprising result? Ta-da: 14.7% of the folks in the paid group stopped smoking within the first year, compared with 5% of nonpaid group. And after 15 or 18 months, 9.4% in the paid group were still smoke-free, compared with 3.6% of the nonpaid group.

So perhaps the best use of wellness dollars is not in the program itself, but in the incentives? What do you think? How can employers get the best return on their wellness investments? Comment and let me know.

Tip of the Day: Five 401(k) fixes

The Wall Street Journal recently published a list of five ways to fix their 401(k). Easy at that, huh? Read it, and then comment on what tips would be on your list.

Here, I'll start: Create a family budget. This is pretty basic, but has helped my family tremendously. I suspect that many families -- like mine until recently -- don't really know where all of their money is going. Seeing it all in black and white helped us see where we could trim the fat to put toward saving.

News You Can Use: Target-date funds falter

Is any retirement vehicle safe? I keep looking, but all I see are returns that are the financial equivalent of auto crash tests where the dummy's body snaps all around then slumps over the wheel. Know what I mean?

Although target-date funds were supposed be set it and forgettable savings vehicles for employee-investors -- pick your dream retirement date and let the fund do the rest -- a recent Wall Street Journal report cites data from Morningstar that show that some 2010 funds have lost as much as 20%. Among other funds, Morningstar examined 275 of them, and found 50 posted more than 38.5% drops in 2008, including the Oppenheimer 2010 fund, that lost 41.3%.

Yikes.

Mark your calendar to check out an EBN report on 2010 funds in our March issue.

What has been your experience with target-date funds? Comment below.

News You Can Use: President-elect sets ambitious work-life agenda

Among his many large scale goals, President-elect Barack Obama has set a high-flying work-life agenda, including a federal mandate for paid sick leave and expanding FMLA to encompass employers with 25 or more workers (current law applies to 50 or more), more purposes -- including children's school needs, and expand care to more family members.

Read more here from the Wall Street Journal about Obama's work-life proposals and others on the federal and state level.