Reducing costs through better care collaboration

This is an excerpt from an article in the Healthcare Finance News. Click here to access the full article.

For the past several decades, the U.S. healthcare system has rewarded the provision of high-volume, specialized patient care—and, as a result, we have seen costs skyrocket and our collective health suffer.

By contrast, the patient-centered medical home (PCMH) healthcare delivery model is a collaborative, team-based approach with the primary care physician (PCP) at its nexus. With financial and clinical risk shared among providers and health plans, it has the potential to not only improve care, but also to contain costs.

If there is one thing the healthcare industry has learned, it is that chronic illness drives high costs. Chronic illness often is rooted in poor preventive health habits and is responsible for a large portion of patient encounters in the current delivery system. In fact, some 70 percent of deaths in the United States are the result of preventable conditions, generally caused by diet, lack of exercise, smoking, and obesity.

Take, for example, the many diabetic patients who suffer from multiple co-morbid conditions. Under the current highly fragmented healthcare delivery system, they often receive care from several different physicians. With no collaboration among providers, these patients are subject to gaps in care, redundant testing, and greater exposure to medical error.

By contrast, the PCMH model offers financial incentives for PCPs, specialists and healthcare plans to share their data—thereby avoiding redundancies and identifying gaps in care before they result in hospitalization and emergency room visits. A 2009 study of a PCMH pilot in Seattle showed that after one year, patient ER visits declined by 29 percent and hospitalizations dropped by 11 percent versus a non-PCMH control group.

Wellness programs aren’t new, but new accountable care models like PCMH have the power to make them more effective, with more patient stakeholders invested in their positive change. Ultimately, lower costs will come when financial and clinical incentives spur providers and payers to hold patients accountable for the kinds of behavioral changes that lead to better health.

Read the rest of this article to learn how technology can be used as a bridge and how quality and cost of care can be aligned.