High-cost patient populations: 3 areas to address

January 02 01:00 2016 by ushadmin

We all know the saying that 20% of patients drive 80% of costs. Historically, hospitals have struggled to find ways to care for this high-cost population. They have also struggled with how to implement programs as the nation rapidly evolves from fee for service (FFS) to value-based care (VBC) methodologies. By 2020, several of the nation’s largest health care systems aim to have 75% of programs reimbursed under VBC.

The solution is to start inside the hospital with those challenging high acuity patients and build the systems that support them in returning to and staying in their homes. It’s a new “inside out” approach to population health to ensure seamless and integrated coordination along the continuum of care. To secure the benefits of this approach, there are three key areas to address. These include:

The time after patients are discharged to when they are seen by a provider is often referred to as the black hole of healthcare. Skilled nursing facilities (SNFs) are one way to ensure patients, especially those who are frail, better transition from the hospital back to home. However, historically, about 25% of patients admitted to a SNF end up back in the hospital. With Medicare penalizing hospitals (and SNFs as of 2018) for readmissions, there is greater emphasis on how to get more value from these facilities.

One especially promising trend is when inpatient physicians or hospitalists follow their patients to the SNF facility. The physician already knows the patient’s status, medications, history, etc., and can ensure better transition from hospital to SNF and ultimately to the home setting.

Another promising emerging model is the post-discharge clinic to ensure patients have a source of information and support in the critical few days after they leave the hospital. Upon discharge, patients and their families are often overwhelmed with information and the recovery process. Few are able to schedule a visit with their busy primary care physician, if they have one, within a few days. Post-discharge clinics ensure patients have access to a physician, ideally the same one that provided hospital care, within 48 to 72 hours of discharge. This gives the patient a chance to get settled, recover more fully and think about the questions and concerns they may still have.

Post-discharge clinics can work in tandem with urgent care centers (UCCs). However, their primary role is to care for patients immediately after discharge and to help with scheduling routine tests and medical visits. It is not necessary for the discharge clinic to be a separate brick and mortar facility, making it a cost-effective solution. It can be a unit within the UCC, the emergency department (ED) or elsewhere in the hospital.

While a newer strategy in healthcare, early programs are showing considerable promise. At one mid-size community hospital on the West Coast, over a four-month period in 2015, none of the patients admitted to the hospital, who were subsequently seen at the post-discharge clinic, were readmitted to the hospital…