A recent New York Times article tells the story of Jerome Pate, a homeless man who visited the Emergency Room 17 times in 4 months last year. He would go if he was sick. And he would go if he was cold, or drunk, or hungry, or suicidal. In other words, he had a lot of visits, for minor or nonexistent medical problems, with a serious root cause (in this case, his homelessness). Mr. Pate was a super utilizer.
“We had this forehead-smacking realization that poverty has all of these expensive consequences in health care,” said Ross Owen, a county health official who helps run the experiment here. “We’d pay to amputate a diabetic’s foot, but not for a warm pair of winter boots.” This type of pattern would have actually been a cost center in the old medical system. When you're paid by the visit, many visits for small or nonexistent problems actually work in favor of the hospital in terms of profit.
In an age of penalties for readmissions, and pay-for-performance being the rule of the day, this is not a strategy that works.
More than 11 million Americans have joined the Medicaid rolls since the major provisions of the Affordable Care Act went into effect. For those patients, as well as for Accountable Care Organizations and managed care hospital systems, super utilizers can be a major source of costs -- as well as care that doesn't really meet the patient's needs.Some people have expensive problems that are only solved by many hours of a single specialist. But some of the largest shares of spending are actually from the super utilizers who are racking up costs with very simple problems.
Hospitals and providers who use iClickCare have been finding that the needs of super utilizers can be best met with the support of telemedicine. When providers collaborate across the spectrum of care, it is much easier to deal with patients who have nonmedical issues exacerbating or causing their primary compliant. It allows providers to communicate on their own time, across buildings, and spanning visits.
Here are 3 ways telemedicine and medical collaboration can help you care for super utilizers and make sure costs are contained:
- Stop people from falling between the cracks. With Mr. Pate, for instance, the hospital's procedures and systems made it so that each time he came in, the ER team assessed and/or treated him for the medical concern he presented with. Even if the providers in the ER were aware of the nonmedical issues he was facing, they had no good way to connect him to the services he needed -- services that may have prevented him from circling back to the ER the very next week. With a medical collaboration platform like iClickCare, an ER doc could leave a question or consult for a health outreach or social service worker at 3am and that other provider could connect with the patient or the original doctor the next day.
- Create a broad treatment team. Because medical collaboration lets you create a treatment team across the spectrum of care, the components of a patient's problems that are less directly "medical" can be cared for. A collaboration in iClickCare, for instance, can include teachers, health outreach workers, social workers, the ER doctor, a specialist, and a primary care doctor. All sharing their thoughts and questions on their own time, in a single place.
- Resolve the root problem the first time. In Mr. Pate's case, he was 17 visits in and his root problem -- his homelessness -- still hadn't been addressed. It is better care (and more cost effective) to buy a person a pair of winter boots than to amputate a diabetic's foot. And a telemedicine platform can allow providers to get to the root of the problem through collaboration and continuation of care -- without allowing things to get bad, painful, and expensive.
For our complete Quick Guide on telemedicine, click here: