A recent article discussed how addressing the social problems of hospital emergency department (ED) super-users can results in substantial savings for hospitals (see: Tackling Patients’ Social Problems Can Cut Health Costs). Below is an excerpt from it:
[S]uper-utilizers of healthcare services] 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 (see: Addressing the One Percent: An Interview with Jeffrey Brenner, MD).....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. Jeffrey Brenner has sought to change the way the health care industry treats people with complex problems.....This high touch, data-driven approach [of addressing super-utilizers' social problems] has yielded big savings. ER visits for ...[a study group of them] dropped by 40 percent, cutting monthly hospital bills from $1.2 million dollars to $500,000. Since then, Brenner has sought to spread the model around the country. One example is the Patient Care Intervention Center [PCIC] in Houston....Tackling that problem took unprecedented planning among typically disjointed city and county agencies, hospitals and nonprofits.
There is no big surprise here. A large number of hospital ED super-users have major social problems such as homelessness, mental illness, and alcoholism. Addressing some of these problems in collaboration with agencies and non-profits can improve hospital budgets. Although hospitals may reap most of the benefits of this reduction of unnecessary ED visits, they are not in a position to independently intervene. However, ACOs working in concert with "disjointed" city and county agencies and non-profits can improve the situation.
Click through to the web page of the Patient Care Intervention Center in Houston for more information about how one successful organization is taking steps to help solve this problem. As the excerpt above indicates, part of its approach entails data analysis to identify the super-users. Recall that hospitals control access to some of the most important data in this regard. Here's some information about the Unified Care Continuum Portal (UCCP) from the web site of the PCIC:
...[The UCCP] is a web based system that is being developed to provide a single point of access to a client's plan, which would span services rendered to the client from multiple organizations. This will enable providers and coordinators to view the entire continuum of care being provided to a client, rather than just their own care plans. It will enable better coordination between systems, and reduce any overlap in services that might currently exist due to a lack in coordination. It will also establish a more streamlined and coordinated case management process with the client. The UCCP will be built on top of PCIC's web-based Electronic Medical Record (EMR) system, integrating into existing care coordination and care plan functionality that is already present in the system.