Controlling costs by focusing on expensive patients

Dan Gorenstein Nov 11, 2015
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Controlling costs by focusing on expensive patients

Dan Gorenstein Nov 11, 2015
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Medicaid health insurers are meeting in Washington this week, and one issue at the top of the industry’s agenda is taking a look at social factors that many Medicaid directors believe drive up E.R. and hospitalization rates for a small number of patients.

There’s a growing sense among states, which employ the insurers, that providing better care to some 5 percent of patients overall — a group that accounts for half of medical spending — is essential to lowering program costs long-term.

Allison Hamblin with the Center for Health Care Strategies said states increasingly expect companies to tackle “housing, jobs, social isolation and nutrition,” for a subset of high cost patients.

The question, Hamblin said, is in the approach. For example, should an insurer pay rent for a patient who is homeless and is admitted to the E.R. several times a month? It’s a major policy issue for the $165 billion industry.

Manik Bhat with the firm Healthify said many in the industry buying in philosophically that the so-called social determinants of health matter, but he said no one is sure what steps to take.

“We don’t know if an intervention is going to work and what the result is really going to be,” he said. “The data’s just not there yet.”

But Bhat said that may change soon. He said about ten insurers are investing in R&D to see if addressing non-medical social needs can improve care and lower costs. 

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