Unless you’re holed up in a cave somewhere you know that Congress and the President are at odds over Obamacare. The continuing battle between the two has led to the government shut down. Many in Congress believe the President’s health care law will continue to drive up health care costs. The President believes providing coverage options to all Americans will decrease the number of uninsured and stop the price shift of the uninsured to the insured.
A lot of the discussion and bickering is political and it would be great if just as much energy were applied to finding real ways to reduce health care costs. So that I’m not a part of the problem, I have a proposed solution. Let’s look at better ways to coordinate care which will reduce health care cost in our country.
1 percent of the patients in our country battling multiple chronic illnesses consumed 21 percent of the nearly $1.3 trillion Americans spent on health care in 2010, at a cost of nearly $88,000 per person. Five percent of patients accounted for 50 percent of all health-care expenditures. By contrast, the bottom 50 percent of patients accounted for just 2.8 percent of spending that year, according to a recent report by the federal Agency for Healthcare Research and Quality.
There’s no question that chronic illness can be expensive and the sicker you are the more it will cost to care for you but better care coordination could go a long way to reduce health care spending in the US. Receiving the right care, at the right time, in the right place is an important aspect of controlling health care cost. It’s not cost-effective for someone with a chronic illness to receive primary care in the emergency room setting.
It would be more cost-effective for a patient with a chronic illness to have better access to a primary care physician and even though an ambulance can’t take a person to the physician’s office it would be more cost-effective for Medicare or Medicaid to pay for regular medical transport to a physician’s office if transportation is a road block to care. It would also make sense for Medicare or Medicaid to provide payment for “house calls”.
If a person with a chronic illness were visited in their home daily or weekly by a nurse the nurse could monitor change in condition and medication compliance and make changes before the patient’s condition worsens. Currently, Medicare will only pay for these services if the patient is considered home bound which means the patient can’t physically get out of their house. When you are so sick that you can’t get out of your house any worsening of your condition will get you a ticket to the hospital. If home health services were provided prior to a patient becoming so sick he can’t leave his house then even if his condition worsens he can be treated, and recover, at home which is much more cost-effective than a hospital or emergency room.
Someone still needs to coordinate the care for those high volume consumers and it can’t be someone hundreds of miles away with no medical knowledge. One nurse could coordinate the care for dozens of people and could do so in a cost-effective manner. If just a couple of hospital admissions were prevented each month the nurse’s salary would be paid for many times over.
Real solutions come from realization of the problem. It’s time for us to rethink our care delivery model.