Major Healthcare Issues I Think IT Could Help Solve

Yesterday and today I spent my time at the Accountable Care Expo in Las Vegas. It was a small intimate event, but those that were there were some really smart people who knew a lot about healthcare and about accountable care organizations. It was quite the education for me. Plus, as with most learning, as I learned more about ACOs I realized how much more I still don’t know.

During the conference I started to think about something I’d heard quoted quite a few times. At this conference they said, “3% of patients are consuming 60% of healthcare dollars.” I’ve heard a lot of different numbers on this. I remember hearing that 10% of patients have 80% of healthcare costs. Regardless of the exact numbers, I’ve heard this enough to believe that a small number of patients drive a abnormally large portion of the healthcare costs in this country.

When you think about this, it becomes quite clear that these “expensive patients” are likely those with chronic conditions. That’s the easy part. The harder part is that I’ve never seen anyone analyze the makeup of the 3-10% that are driving up healthcare costs. For example, what if 90% of those “expensive patients” are chronic patients over the age of 65. Solving this problem would be very different than if we found that 50% of expensive patients are diabetics under the age of 20.

How does this apply to health IT? First, health IT should be able to sort through all the big data in healthcare and answer the above questions. How is anyone going to solve the problems of these “expensive patients” if we don’t really know the makeup of why they’re so expensive?

Second, I believe that some health IT solutions can be implemented to help lower the costs of these chronic patients. I’ve seen a number of mHealth programs focused on diabetes that have done tremendous things to help diabetic patients live healthier lives. That’s a big win for the patients and healthcare. We need more big wins like this and I think IT can facilitate these benefits.

Since this post has taken a slight diversion away from my regular topics, I wanted to look at another thought I had today about healthcare. This tweet I sent today summarizes the idea:

All of the numbers I’ve seen indicate that hospitals are the most expensive part of healthcare today. Hospitals are just expensive to run. They have a lot of overhead. They work miracles regularly, but they come at a cost. While more could always be done, I feel safe saying that many hospitals have squeezed out as much cost savings they can out of the hospital. This means that in order to save money in healthcare we can’t strip more cost savings out of hospitals. Instead, we need to work to keep patients from going to the hospital.

There are a lot of ways to solve this problem (I heard of one payer putting instacare clinics next to ERs to save money), but the one I hear most common is the need for primary care doctors to have a more active role in the patient care. If they had a more active role once a patient is discharged from the hospital, then fewer patients would be readmitted to the hospital.

How then can we structure a program for primary care doctors to be paid to keep their patients from being readmitted to the hospital? That’s the million dollar question (literally). Everyone I know would happily pay a primary care doctor a half a million dollars in order to save millions of dollars in hospital bills. That extra money might also help us solve the primary care doctor shortage that I hear so many talk about.

I can’t say I have all the solutions here, and I don’t expect these things to change over night. Although, I think these will be important changes that will need to happen in healthcare to lower costs. Plus, I think IT will facilitate an important role in making these changes happen. Imagine something as simple as an HIE notifying a primary care doctor that their patient was admitted or discharged from the hospital. This would mean the doctor could go to work. Now we just need to find the right financial mechanism to be sure they act on that notification.

I’ll be chewing on these ideas this weekend. I look forward to hearing other people’s thoughts on these issues.

About the author

John Lynn

John Lynn

John Lynn is the Founder of the HealthcareScene.com, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference, EXPO.health, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.

5 Comments

  • How hard could it possibly be to set up a pilot or test of concept study where appointments with the PCP are significantly longer (perhaps twice as long as standard) and the PCP office has a care manager, and then see over 18 months what the total costs for the patients are?

    Peter

  • The challenge, as in every matter, is resource constraints. Labor management is one of the highest opportunities to capitalize on. This often challenges the appropriate patient:staff ratio. Identifying the high risk patients and putting a ‘care team’ together to educate, not only the patient, but additionally those responsible for the overall well being of the patient is a critical step in the cure. There are often family members responsible for finances, home care, dietary needs, etc. Having an inclusive consultation to set expectations prior to discharge could have a significant impact on re-admissions, as well as, the overall well being of the patient. This is not a terribly difficult program to implement if you have the means to digest and analyze the data. Relying exclusively on EMR/EHR systems, often times, does not provide the insight at a high enough level required to identify the outliers within the total census.

  • I think you’ve hit the nail on the head with this article. With so much of our healthcare expenditures going to treat preventable chronic diseases, why are we not empowering primary care doctors to do more…prevention? PCPs are the first line of defense in the health care system but are overburdened and underpaid. The Medical Home concept is proving very effective at caring for chronic disease patients by involving doctors, nurses and health coaches to provide health management and monitoring services outside the 15 minute office visit. Other models such as Direct Primary Care (www.qliance.com, http://www.iorahealth.com) are also highly effective. But as you mentioned, this comes at a cost (A primary care practice Iora Health set up in cooperation with Dartmouth-Hitchcock costs roughly twice as much as standard primary care).

    In my opinion the question is as much about about how much physicians would be paid, as it is about who will actually pay. Insurance reimbursements for preventative care and wellness management are terrible, so the incentive is for primary care physicians to fill their schedules with as many patients as possible rather than devote more time to each patient. Most doctors that I’ve spoken with would love to spend more time talking to and working with each patient, but the current reimbursement constraints simply don’t allow for it.

    I’d love to hear more thoughts on this from all sides. For what it’s worth, I’m working with a startup trying to address this precise issue of encouraging prevention and management over fee-for-service care, and using technology (especially mobile devices) to do it.

  • Your statement, “the need for primary care doctors to have a more active role in the patient care” struck me.

    I certainly agree that PCPs are generally not as involved in ongoing patient care as they could be, but what seems even more important to me, is for patients to take a more active role in their own care.

    So maybe there is an opportunity for IT innovation to increase both of these at once. Perhaps an app that allows for PCPs to track patients’ progress in between office visits, and educates patients on the importance of adhering to their PCP’s advice?

  • Sam Meyer,
    Great addition to the conversation. I think it’s almost all about the reimbursement. It’s not that doctors don’t want to do this, but they don’t want to work for free either. So much of the Wellness stuff is not reimbursed. Although, I imagine from the payer side it’s hard to know what exactly a doctor did for “Wellness.”

    Rick,
    I agree it would be great if patients took more responsibility. I just don’t see that happening. The exception could be for the high deductible plans that many are getting. Once you start paying for the care you’re getting, you take a different approach to how you deal with your health.

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