Wednesday, August 31, 2016

High Need, High Cost Patients

Been awhile since I have posted on this blog.  I have cut back on my health reform agenda as I have focused on other projects, especially on investment education in my leadership roles with AAII and with criminal justice projects, as Chair/President of Safe Silver Spring.  Also, active in politics and promotion of a preview showing of Denial" a film about a famous Holocaust denial trial.

I do post articles quite often on the following facebook page as well as my facebook page at Tony Hausner.

Recently, I noticed that the Alliance for Health Reform was sponsoring a program on: High Need, High Cost Patients.  Karen Davis, now at Hopkins was one of the key speakers.  I am a longtime fan of Karen.  Here is what I shared on facebook afterwards.  Alliance for Health Reform and Commonwealth Fund hosted a C-span forum  on High Need, High Cost Patients: Challenges and Promising Models. The paper here was part of the package and lays out some of the key issues.  The forum presenters discussed the needs and potential solutions. An excellent discussion.  Very glad that I attended.

These patients cost $21,000 per person per year which is 3 times adults with multiple chronic diseases but no ADL limits and 4 times the average adult.  

More of the Alliance program can be seen here

Here are a few thoughts that I wrote up afterwards on addressing these and related issues. Many of these are consistent with what others including the panel members have said.  
  • Greater integration of post acute services
  • Greater integration of Medicare/Medicaid programs for duals
  • A more comprehensive long term care services system that is affordable
  • Greater integration of health and other human service programs, etc. 
  • More comprehensive quality outcome measures. And greater integration of measures across services.  Each service has unique measures right now, e.g., home health and nursing homes are very different sets
  • I particularly like Atul Gawande's paper on "The Hot Spotters"
  • Electronic data systems need much greater integration.  A great deal of work needed to develop compatible systems between health care services and even within a given service. Partly tied to quality measures above but need for more consistency even within a given service, e.g., many different hospital systems.  
  • More rigorous evaluation research strategies.  CMS has gotten away from the model that we used in the first 35 years of the program.
I welcome comments on these issues and encourage folks to review the above papers.