Leaders on Beacon Hill should know that one of the key factors driving up health care spending is poorly managed and uncoordinated care delivery. Too often, patients are getting treatment from multiple providers that don’t talk to each other and lack any incentive to work together to keep costs down. This raises the overall price tag, and doesn’t result in better care.
Population health management — that is, coordinating health care in a more organized and informed fashion — is critical to improving results, and will entail three key factors: identifying and supporting the sickest patients, minimizing or preventing disease progression, and promoting a culture of health.
Better collaboration between payers and providers, and a mutually beneficial change in compensation and reimbursement that pays for outcomes, not use, will both be critical to the success of these initiatives.
Care management that supports the sickest patients
Five percent of the population will drive 30 percent of next year’s health care costs. Identifying these patients early and implementing proactive disease and case management will enable both payers and providers to cut down on spending and improve care.
Inappropriate management of high-cost conditions like diabetes, asthma, and hypertension is one of the leading causes of excessive spending. Due to the nature of fee-for-service financing, the sickest patients often fail to receive preventative care — which can lead to hospitalizations and emergency room over-utilization. In other words, appropriate care is often delivered in the most expensive settings.
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