We are at the front lines of providing health care for some of the poorest and sickest people in Spokane. We know there has to be a better way to help someone who has had a cold for three days then having them call 9-1-1 to secure ambulance transport to the ER.
Sometimes we might think we are alone in facing this predicament, but communities all over our nation are seeing the same thing. In Camden NJ, studies showed that one percent of the population was responsible for 30% of medical costs. This article in the New Yorker tells the stories of physicians and other health care professionals who are tackling the problem. Some of the conclusions they have come to are counter-intuitive, but seem to work.
From health coaches and teaching people how to cook their own meals to institutionalizing patients unable to care for themselves, the responses to the problem are diverse. Here are a few tidbits, if you don't have time to read the story:
Brenner and his team are out there on the boulevards of Camden demonstrating the possibilities of a strange new approach to health care: to look for the most expensive patients in the system and then direct resources and brainpower toward helping them.
“Take two ten-year-old boys with asthma,” he said. “From a disease standpoint, they’re exactly the same cost, right? Wrong. Imagine one of those kids never fills his inhalers and has been in urgent care with asthma attacks three times over the last year, probably because Mom and Dad aren’t really on top of it.” That’s the sort of patient Gunn uses his company’s medical-intelligence software program to zero in on—a patient who is sick and getting inadequate care. “That’s really the sweet spot for preventive care,” Gunn said.
The critical flaw in our health-care system that people like Gunn and Brenner are finding is that it was never designed for the kind of patients who incur the highest costs.
For a pedestrian hit by a minivan, there’s nowhere better than an emergency room. But these institutions are vastly inadequate for people with complex problems: the forty-year-old with drug and alcohol addiction; the eighty-four-year-old with advanced Alzheimer’s disease and a pneumonia; the sixty-year-old with heart failure, obesity, gout, a bad memory for his eleven medications, and half a dozen specialists recommending different tests and procedures. It’s like arriving at a major construction project with nothing but a screwdriver and a crane.
The Hot Spotters
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