Tackling Patients’ Social Problems Can Cut Health Costs

January 25, 2017

The following is an excerpt from an article on Kaiser Health News by Sarah Varney:

Patients like the Houston man are health care’s so-called “super-utilizers”— people with complex problems who frequent emergency rooms for ailments more aptly handled by primary care doctors and social workers. They cost public and private insurers dearly — making up just five percent of the U.S. population, but accounting for 50 percent of health care spending.

As health care costs continue to rise, hospitals and doctors are trying to figure out how to find these patients and get to the root of their problems.

An effort to do just that started in New Jersey’s poorest city, Camden, more than a decade ago. Inspired by the way police departments mapped crime data to detect “hot spots,” family physician Dr. Jeffrey Brenner dug into ambulance records and emergency department data to show how high-cost patients were shuttling between city hospitals.

“In America, we’re medicalizing social problems and we’re criminalizing social problems, and we’re wasting huge amounts of public resources,” Brenner said. “We have the wrong tools to solve the wrong problem.”

To steer patients away from expensive emergency care and push health systems to change the way they do business, the Affordable Care Act funds programs called Accountable Care Organizations. These are networks of hospitals, physicians and others who team up to improve care, lower costs and reap the savings.

This high touch, data-driven approach has yielded big savings. ER visits for the first group of patients dropped by 40 percent, cutting monthly hospital bills from $1.2 million dollars to $500,000.

Read the full article on KHN.org.