What causes a frail elderly person to become a patient in the hospital and can we do something in the home to prevent that event? What causes some people to develop chronic illnesses and can other people intervene to prevent the consequences of those illnesses?
What if healthcare reformers asked these questions rather than focusing (or appearing to focus) only on costs? Better yet, what if they recognized the system changes that work, rather than insisting that all doctors must become employees of mammoth organizations, touting the business opportunities inherent in expensive, user-unfriendly electronic medical records and/or forcing an even more expensive change from the 5-digit medical diagnosis codes in ICD-9 to the 7-digit ICD-10 codes?
The source for the graph above is a report by the Oliver Wyman Healthcare Innovation Center, reviewed in Forbes Magazine last January by author Dave Chase. Yes, 5% of patients are responsible for 45% of the costs. What works to lower costs? Taking care of the patient:
In 2008, when physicians from CareMore, an independent medical group based in Cerritos, California, heard news reports of a brutal heat wave, they began contacting their elderly emphysema patients. Physicians worried that the scorching heat would drive their at-risk Medicare Advantage patients to the emergency room. So when patients said they had no air conditioner, the physicians purchased units for them. The theory was that the roughly $500 cost paled in comparison to the cost of an emergency-department admission. As it happened, this non-medical “intervention” kept CareMore’s patients out of the hospital. But if they had needed to go and lacked transportation, CareMore would have offered a free ride.
CareMore has an expansive, counter intuitive approach to healthcare. The group fends off falls by providing patients with regular toenail clipping and by removing shag rugs—a common household risk for the elderly. Patients engage in iPhone conference calls with healthcare professionals and are remotely monitored with devices that feed data automatically to doctors; for example, patients with congestive heart failure are given a wireless scale that reports their weight on a daily basis—a key step in preventing hospitalization. They have singing pillboxes that chime when it’s time to take medications.
These unusual tactics produce enviable outcomes: CareMore’s hospitalization rate is 24 percent below average, hospital stays are 38 percent shorter than average, and the amputation rate among diabetics is 60 percent below average. Overall member costs are roughly 18 percent below the Medicare average.