Care redesign should begin with high-risk patients

Signs saying healthcare reform
In order to truly reform healthcare and reduce costs, leaders must start at the top and address the sickest patients who account for a huge portion of healthcare spending. (Photo credit: Getty/Eugenia Chaikina)

To truly reform healthcare and reduce costs, leaders must start at the top and address the sickest patients who account for a huge portion of healthcare spending.

Indeed, the sickest 5% of patients account for almost half of the healthcare spending in the United States, wrote Zubin J. Eapen, M.D., chief medical officer, and Sachin H. Jain, M.D., president and CEO, of CareMore Health System, a division of Anthem, in an article for the Harvard Business Review.

These patients are often at the end of life and are frequently hospitalized, so finding ways to avoid unnecessary hospitalizations and improve care for them is key to reducing overall spending.

The CareMore Health System, for example, has an intensive chronic disease management program that allows physicians to follow patients across the spectrum of care for better coordination. A strong continuity of care and effective communication can keep patients from unnecessary admissions.

Another way to better connect these patients with outpatient services is to ensure they’re able to get to them, they write. To accomplish this, some providers partner with ride-sharing services like Lyft and Uber, which has been shown to improve care access and help patients and providers both save money.

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