Are We Spending Too Much Trying to Lower Overall Healthcare Costs?
A recent report from Drs. David Nace and Kanav Hasija of Innovaccer, Inc. identified 15 “key levers” driving value-based care success in a post-pandemic environment. The authors suggest that these processes are the areas that healthcare organizations must address to succeed in a new normal world.
The report documents that nearly 34 percent of all healthcare payments made in 2017—representing approximately 226.3 million Americans and 77 percent of the covered population—used an alternative payment model with shared savings, shared risk, bundled payments, or population-based payments. And alternative payment models are likely to increase post-pandemic.
Of the 15 key levers this report suggests as drivers of overall healthcare cost savings strategy, 10 – or two thirds – are significantly enhanced by employing an innovative approach to home care services:
Reducing 30-day hospital readmissions: This is obviously a priority cost-avoidance strategy for any at-risk organization. Readmission rates have ranged from 15–19 percent or even higher, and accountable care organizations (ACOs) expend significant resources to lower this figure. Lowering rates of readmission requires frequent patient contact to assure adherence to treatment regimens and early detection of developing problems with physical or mental health. Contact with recently discharged or frequently admitted patients is often carried out by Care Managers who also provide a range of services, arrange timely interventions, and incur significant overhead to the ACO. This service can be delegated to callers with less clinical training, who use monitoring protocols and Artificial Intelligence (AI) tools to identify and report those patients requiring priority intervention yet incur significantly less overhead.
Reducing SNF costs: Most at-risk healthcare delivery organizations want to move Skilled Nursing Facility patients to lower intensity and less costly care sites such as home care as soon as possible. SNF costs currently average between $10–14,000 per admission compared to $3,000 for clinically-based home healthcare but even less for sustained home monitoring services. Most clinical home healthcare is intermittent and relatively short term while effective support of patient independence requires on-going contact to attain patient stability in an outpatient environment. This is done most efficiently using frequent voice contact with AI monitoring.
Reducing ED visits: The cost of Emergency Department visits is exceptionally high. Missing subtle changes in physical or mental condition due to infrequent communication or subtlety of presentation can lead to missed opportunities for less expensive home or office visits and incur much higher care delivery costs. Again, AI monitoring of frequent voice contact provides cost savings over other contact methods.
Increasing medication adherence: Almost 10 percent of total healthcare cost is estimated to be due to medication non-adherence – that represents $300 billion of preventable healthcare costs. Ongoing frequent oversight of medication adherence avoids expensive destabilization problems from missed or confused home medications. This service can be provided effectively by protocol-driven, non-clinical callers.
Improving quality measures: Hundreds of quality measures are used to track performance in value-based care settings and often influence individual provider compensation. One key measure is patient (and family) satisfaction and that is maximized by frequent, consistent, patient-centered, and friendly contact.
Retaining low-risk members: Patients who are not high utilizers can also create value by having their needs met efficiently and effectively – usually improving their health outcomes – by frequent contact, assessment, coaching, and empathetic relationships that can be accomplished by non-clinical personnel.
Managing chronic conditions: Medication management, communication with the patient, family, and providers to coordinate care and monitoring care plan adherence are vital to minimizing progression of disease and complications as well as slowing deterioration of independence and loss of activities of daily living. Unless complications emerge, this can be done by voice contact monitoring enhanced by AI.
Addressing social determinants of health (SDOH): An understanding of each patient’s goals, lifestyle and circumstances is critical for optimizing interventions designed to minimize episodes of high-cost care. This takes establishing real relationships by frequent and consistent contact by caring individuals, not necessarily from highly trained clinical personnel.
Managing referral patterns: Coordinating care among in-service and out-of-network providers can prove difficult and time-consuming. It requires time, patience, and reinforcement to be sure patients are utilizing the right providers and pharmacies for their home ACO. This service is also available from protocol-driven callers.
Reducing network leakage: To provide fully integrated care, healthcare organizations need to ensure patients have access to all available services without going out of network. Network leakage is often avoidable with focused coordination and reminders of within-network appointments easily reinforced by frequent, personalized voice contact.
The remaining key levers suggested by Nace and Hasija are in the hands of individual practice groups:
- Preventing unnecessary tests;
- Increasing generic drug use;
- Renegotiating contracts;
- Improving coding accuracy; and
- Optimizing risk portfolios.
The Innovaccer report concluded, “Value-based care is not guesswork. In the post-pandemic world, we need to focus more on driving value in the way we deliver care…To become successful in VBC, it is imperative that organizations begin to tackle their most significant value levers with a systematic and laser-focused approach.” Cost-effective monitoring post-acute care to complex, complicated, and potentially costly patients requires frequent contact and assessment delivered at the lowest cost. Protocol-driven and AI-enhanced monitoring delivered by low-cost, empathetic and friendly callers is available today to help at-risk organizations limit their expenditures for preventable, high-cost care.
Glenn Mitchell, M.D., is Chief Medical and Technology Officer at Constance
