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Reducing hospitalization for seniors The role of a life care manager By Joel Theisen, RN, and Dave Moen, MD
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s the impetus for value-based care continues to grow, reducing hospital admissions for seniors remains a top priority for payers and providers alike. According to the 2014 Healthcare Cost and Utilization Project Statistical Brief on hospital stays, spending on hospitalizations accounted for 29 percent of all health care expenses, making them one of the most expensive types of health care treatments. In 2014, nearly 18 percent of Medicare patients who were hospitalized were readmitted within a month, costing an estimated $26 billion, with $17 billion coming from potentially avoidable readmissions. For Minnesota, the impact has hit 27 percent of the hospitals with 36 being penalized for high readmission rates. There remain large-scale opportunities for further reductions and cost savings.
Dealing with high utilizers No easy solution By Robert L. Kane, MD
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ealth care’s movement toward a value-based model increases the pressure to reduce costs. Two cost reduction targets immediately come to mind: 1) eliminating unnecessary or ineffective care, and 2) addressing high utilizers. It has long been recognized that a small group of patients (of every age) account for a disproportionate amount of care. For health care organizations, patients who use a lot of services pose a problem. High utilizers have become
While physicians have readily available solutions for acute problems, there have been inadequate and often unmeasured solutions for chronic and complex health and social problems, especially in the community. The easy way out was all too frequently to send them to the Emergency Department (ED). In fact, new Reducing hospitalization for seniors to page 12
pariahs because they make disproportionate demands for care that make poor economic sense in a fixed-price environment. Even if payers cover their costs, high utilizers challenge clinicians to find ways to address their multiple complex interactive needs. Care providers seek effective ways of managing these complex cases. Continued effort is feasible (and desirable) if value-based payment Dealing with high utilizers to page 10