Earlier this month, we shared the challenges of coordinating care for complex patients and how care coordination can reduce unnecessary utilization. Today, we’re sharing part three and focusing on how collaboration can decrease care costs.
Unnecessary inpatient and ED utilization drive up care costs. For example, the Alaska Department of Health and Social Services found that the top 6 percent of emergency department users accounted for nearly 24 percent—around $148 million—of ED costs in 2016. Organizations can help curb the unsustainable costs associated with avoidable utilization by taking steps to reduce it.
Costs Savings Per Patient
A study of high-need, high-cost Medicaid patients published in the American Journal of Managed Care found that a complex care management program reduced total medical expenditures by 37 percent—a savings of over $7,700 per member per year.
A JAMA study looking at how a comprehensive care management initiative affected cost and utilization changes for Medicare and Medicaid beneficiaries reported promising results when it came to care cost savings. Medicaid patients receiving acute care intervention had lower ED use, resulting in savings of $4,295 per beneficiary per episode. Medicare patients saw an increase in utilization, but a savings of $1,115 per episode, suggesting that less intensive acute resources were needed—still resulting in cost savings.
Cutting Back on Care Costs While Improving Patient Satisfaction
In 2016, Columbia Medical Associates (CMA), a 60+ provider practice in Washington, identified unnecessary ED utilization as an area for improvement. To properly address this issue, CMA needed better information about utilization to enable care management and improve internal processes for accommodating patient needs.
CMA deployed a care collaboration tool that identifies at-risk and complex patients to help staff track and support patients. In just one year, CMA was able to decrease ED utilization by 15 percent and avoidable ED admissions by 7 percent, while increasing patient satisfaction to the point of CMA being #1 in Washington state. These improvements helped CMA reduce care costs by $6.5 million in just one year.
Care coordination, especially for patients with complex conditions, can effectively reduce unnecessary ED and inpatient utilization while helping health providers manage care costs. By doing this, care teams can focus on providing high-quality care to every patient.
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