Monday, June 11, 2012

Six Steps to Saving the Country with Preventive Care

Joe Flower is one of the best healthcare futurists an authors out there… which is why I quote him so often!  In his recent article, "Save the Country with Preventive Care", he explains how we can save the healthcare system by focusing on the treasure in plain sight: "It is those thousands and millions of patients with poorly treated and untracked chronic disease that flood our EDs every day. We can mine those cases to reduce health care costs drastically, put our hospitals and health systems on a sound economic footing, make people healthier and, by the way, save the country."

He then goes on to describe the SIX WAYS to do this, which I will help summarize:
1.      Coverage. Everyone needs to be covered, even illegals and those who won't pay for it - because otherwise they just cost everyone more later on.  He notes, "If they are covered, it is much easier to fashion preventive and outreach programs to keep them from your door."
2.      Shift in risk. He explains this well, "Shift from the standard model (fee-for-service, with all financial risk in the payer) to various models in which the provider takes on some risks (as with bundles, warranties, capitation, minicaps, alternative quality contracts and other models) and the patients take on some risk for making a good decision (going to a clinic or an urgent care provider instead of the ED with a minor matter).
3.      Incentivized wellness. These types of programs "give people financial rewards (such as lower premiums) when they participate and meet simple goals. Correctly done, these programs reduce the actual costs for covering the whole population (including those who do not participate) by 10 percent or more."
4.      Targeting. "Find and go after that 5 percent, that 1 percent who are costing the most money. Some of the cost will be recoverable, some will not; but go after them anyway, because the costs spiral out of control once they cross your threshold."  This includes putting in more clinics in high risk sections of town, as well as "HotSpotting" individuals, as popularized by Dr. Atul Gawande.  There is a lot of energy and momentum to do this - which is a good thing.  I'd just point out at the same time we pour resources into these folks, we need to efficiently take care of the other 95% to make sure they stay stable and healthy (which is a focus of a lot of my recent work).
5.      Public health. Consider how you can better work with your federal, state and local public health officials to address the health needs in your community.
6.      Healthy Communities. "Finally, at the furthest remove from your ED threshold is the Healthy Communities movement. There are local groups in most places across the country, supporting programs dealing with everything from effluents to traffic to education to AIDS awareness. The return on investment is always large because the investment is so small compared with the ED visits, surgeries, premature births, and NICU and ICU use that they eventually prevent."

He finishes with:  "We will save much more money, shore up our finances and help solve the deficit problem when we stop waiting passively for people to cross our threshold and begin aggressively exporting health to those who need it the most."

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