The major change affecting all health care providers in the United States is a shift from volume to value. To this point health care providers have been rewarded by increasing volume the sift we will experience over the next few years is a reward for value and outcomes.
With the shift to value, care coordination will become more important. Care coordination includes helping people access services in the right setting and providing people resources that keep them out of the health care system and helping people better control chronic disease on their own.
Here are a few statistics about Medicaid in Missouri. Once you read these statistics you will better understand how care coordination can help control cost. A recent study by The Missouri Hospital Association found that 5% of Missouri’s Medicaid patients accounted for nearly half of all hospital spending last year. The study also identified 51 Medicaid patients who visited an ED at least 52 times in 2011. 52 visits averages out to one a week and one patient actually visited an ED 132 times (the hospital providing care to this patient may want to think about naming rights…). The total cost of care for these 51 individuals was $5.3 million or more than $103,000 per patient in 2011.
Here’s where care coordination comes into play. Relative to the ED visits, 30% were nonemergent, 21% were emergent but could have been handled by primary care, 5% were emergent but preventable, 3% were mental health related and 2% were alcohol or drug related.
Many of the ED visits could have been treated in another setting. Nearly 60% of the ED visits should not have been ED visits at all. It’s easy to point the finger at the Medicaid recipients in this study and say they made bad choices about where, setting wise, they receive care but the truth of the matter is the ED may have been their only option.
Better coordination of care and better access to primary care may help to reduce Medicaid spending. The former administrator of Medicare and Medicaid Services, Don Berwick, coined the term Triple Aim. The concept of triple aim is to achieve better care, better health and lower cost. Better care coordination for the state’s Medicaid population is one way to achieve the Triple Aim.
The Triple Aim applies to all populations and all payer sources and you will hear me talk more about it in the coming months.