As the health system transitions to a provider centric approach creating Accountable Care Organizations and Patient Centered Medical Homes, being reimbursed by new non-FFS payment methodologies; where will the savings come from? Many of the providers have focused on developing programs that address the obvious excesses in the system associated with poor management and outcomes such as chronic diseases and 30 day readmit programs among others.
This disease/case management approach of better understanding and managing those that cost the most is a very easy to understand model that fits right in with the care delivery system; in fact doctors “get it” because it fits their paradigm. People show up with an illness, they need care, and they, the provider, will do a better job of caring for the patient resulting in lower costs and better outcomes.
Over the short term these systems plan to bend trend and achieve savings by targeting the low hanging fruit. But how will these systems control growth over the longer term when they have wrung these inefficiencies out of the system?
You see our growing health care costs are best represented by:
Think of the bowl as those with illness being managed by your ACO or other provider centric group now at risk for costs or attempting to share in savings. The majority of the growth in health care costs in the Unites States, and why the sink is overflowing, can be attributed to an increase in the prevalence of chronic diseases, many of them preventable; that’s the faucet, which is no longer a trickle. So while the newly structured care systems will focus on the low hanging fruit, those needing care or already in the bowl, resulting in savings in the early years, the influx of newly diagnosed individuals will continue to flood the sink possibly negating these early efforts, but certainly impacting the out years. Until organizations begin to address those that do not have an illness or condition today, but will in the coming years if nothing is done, the flow into the illness sink will continue growing .
Population Health Management is about managing all of the population, those who are ill and those who are not. That is the longer term solution needed to create Accountable Health, a system that focuses on all of the providers patients to reduce risks and better manage care.
Want to know how to do this in your ACO or other provider based system? Just use the contact form below.