US Healthcare spend...are we managing our resources effectively?
I recently attended the Population Health Colloquium and saw an interesting slide that articulated a suspicion I have had since starting practice in 1992. At that time, I was in my first year post residency in Katterbach, Germany running a health clinic serving about 4,000 beneficiaries. Commentary Magazine had an article that addressed the utilization of healthcare delivery and cited a national average of four visits to a primary care provider each year. However, our community was seen roughly six times per year.
At the Colloquium, Dr. Jeff Brenner, leader of the Camden Coalition, presented slides that reflected the spend on healthcare by country along with the spend for social services. The contrast of the overspending by the US compared to all other countries, combined with the underspend on social services reflected the disconnect in funding healthcare and social services by the US.
With the approximate $3T spend on healthcare, 1/3 of which is wasted, and relative underfunding of social services, are we applying resources to the right place in order to manage government health programs to achieve the results we expect?
Remember that healthcare can affect about 10% of the beneficiary’s experience of health while other factors: socioeconomic status, environment, education, behavior (social determinants of health) account for roughly 60%. Taking the wasted investment that is misapplied to healthcare and repurposing it to well-managed social services programs, the impact on health could be significant without increasing the overall spend.
The information on healthcare and social service alignment confirms my suspicion that my military health clinic in Germany reflected an imbalance in resource application. Because access to the clinic was relatively unregulated, it became a default community resource and a social gathering place to the degree that patients would bring their fast food breakfast or lunch and sign in to the clinic to have a social experience in the waiting room with other patients and caregivers. The medical clinic became a surrogate for care/support that would be better provided and managed with other, more appropriate resources.
The Camden Coalition has seen a shift (down) in cost and (up) in outcomes as they address healthcare issues more directly. For example, finding the sickest patients that are homeless, providing them homes, and stabilizing their chronic medical conditions with demonstrably improved outcomes decreased hospitalization, utilization of outpatient services, and resulted in better control of their chronic medical conditions like hypertension and diabetes. By managing the care of patients who are high utilizers, they are achieving a reduction in utilization and improved health outcomes. A current randomized controlled trial involving 800 patients is in progress to determine the causal relationships of intervention and outcomes (vs. the current system where the healthcare resources are accessed without intervention for high utilizers with chronic medical conditions).
As the nation seeks to manage healthcare resources effectively, improve outcomes, and enhance the experience of patients, caregivers, and even providers, considering a better management of health spending by moving to more appropriate and effective interventions is critical. The results of the Camden Coalition represent a fresh and successful approach to managing resources to improve the patient experience of care, drive lower costs of care, and better outcomes that are the stated goals of the national healthcare agenda.
For more information, see the below websites.
Stethoscope image courtesy of cooldesign at FreeDigitalPhotos.net.