Friday, January 21, 2011

Health Care Cost Control

I highly recommend reading this article http://www.newyorker.com/online/blogs/newsdesk/2011/01/atul-gawande-super-utilizers.html describing a strategy called " health-care hot-spotting " to lower health care costs.
This requires dedicated family physicians collaborating in health care delivery teams utilizing medical information technology tools.
As physicians we should learn how to benefit from cost-control.
Looking forward to your feedback.
Yours
Bernd

ABSTRACT: MEDICAL REPORT about innovative approaches to reducing health-care costs. Writer tells about Jeffrey Brenner, a physician in Camden, New Jersey, who has used data mining and statistical analysis to map health-care use and expenses. His calculations revealed that just one per cent of the hundred thousand people who made use of Camden’s medical facilities accounted for thirty per cent of its costs. That’s only a thousand people—about half the size of a typical family physician’s panel of patients. In his experience the people with the highest medical costs—the people cycling in and out of the hospital—were usually the people receiving the worst care. If he could find the people whose use of medical care was highest, he figured, he could do something to help them. If he helped them, he would also be lowering their health-care costs. Describes his work with those high-use patients, which led to the creation of the Camden Coalition of Healthcare Providers. By late 2010, his team had provided care for more than three hundred people on his “super-utilizer” map. The Camden Coalition has been able to measure its long-term effect on its first thirty-six super-utilizers. They averaged sixty-two hospital and E.R. visits per month before joining the program and thirty-seven visits after—a forty-per-cent reduction. Their hospital bills averaged $1.2 million per month before and just over half a million after—a fifty-six-per-cent reduction. These results don’t take into account Brenner’s personnel costs, or the costs of the medications the patients are now taking as prescribed, or the fact that some of the patients might have improved on their own (or died, reducing their costs permanently). The net savings are undoubtedly lower, but they remain, almost certainly, revolutionary. Writer visits the offices of Verisk Health, a data-mining company, which supplies “medical intelligence” to organizations that pay for health benefits. Besides the usual statisticians and economists, Verisk recruited doctors to dive into the data. One of those doctors, Nathan Gunn, guides the writer though the way data mining can be used to identify the most frequent users of health-care facilities and reduce their costs. Writer also visits the Special Care Center, a clinic in Atlantic City, which houses an experimental approach to primary care. Tells about the Center’s leader, Rushika Fernandopulle, and the intensive outpatient care for complex high-needs patients that the Center provides. In addition to physicians and nurses, the Center employs eight full-time “health coaches,” who help patients manage their health. Fernandopulle carefully tracks the statistics of the Center’s twelve hundred patients. After twelve months in the program, he found, their emergency-room visits and hospital admissions were reduced by more than forty per cent. Surgical procedures were down by a quarter. The patients were also markedly healthier. Considers difficulties in implementing these and other innovative ideas on a larger scale, including possible opposition from insurance companies and the health-care lobby.

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