A recent article in the New England Journal of Medicine looked at which group of patients are utilizing the highest number of health care dollars, and what can be done to decrease health care costs in this group of patients. While attempting to decrease the rapid rise in health care costs is important, decreasing the number of hospital visits and emergency rooms visits that patients with chronic health care conditions must endure would also improve their quality of life.
The article looked at the yearly health costs depending on the number of chronic health conditions a person has, a person with one chronic health condition costs about $2,753 in spending, whereas a patient with five or more chronic health conditions, such as hypertension, diabetes, and heart failure, costs about $16,819. A more startling statistic is that 10 percent of patiens in the United States account for about 70 percent of total health care expenditures.
Common sense would say that obviously these are the sickest patients that need increased number of hospitalizations, procedures and emergency room care. What can be done for these patients to reduce costs and keep them out of the hospital?
The article describes several studies which are looking at the concept of employing care management teams, headed by a nurse who has extra training and experience needed to coordinate care. Such coordination has been shown to decrease hospitalizations, decrease duplicate care, and keep costs down. While this may benefit patients and insurers, hospitals often make profits by hospitalizing the same patient several times during a year. And primary care offices, already burden with high patient loads, may find no incentive to participate in such programs.
However, the article also mentioned that the care management team would need to decide if continued aggressive care was needed for a particular patient. While this decision is made all the time for a variety of patients, and for a variety of reasons, such push towards cost containment could result in some very sick patients not being hospitalized when needed. Of course, it all depends on the nurse managers who run these programs and efforts should be made to ensure that they are an advocate for their patient first, and that cost containment is a secondary goal.
One study indicated that the cost savings could be near 11 percent if such a system were implemented, however, given that 70 percent of health dollars are utilized by these patients, that could decrease over all health costs in the United States by about 7 percent.
One day such care management teams may be common place, and could help very sick patients avoid hospitalization while coordinating their care by their team of doctors more efficiently.
Follow the Money – Controlling Expenditures