Giving 'super-utilizers' more care can lower medical costs

Is it possible to lower medical costs by giving complex patients better care? That's what Dr. Atul Gawande set out to learn in a recent article published in the New Yorker.

Anecdotal evidence suggests it is possible. The Camden Coalition of Healthcare Providers, which relies exclusively on home visits and phone calls, has cared for 36 "super-utilizers," of healthcare. Their number of hospital and ER visits dropped by 40 percent--from 62 visits to 37--after joining the program. What's more, their hospital bills dropped by 56 percent--from an average of $1.2 million per month down to just over $500,000--Gawande says.

Gawande describes examples of the intensive "high-touch" outpatient care that complex high-needs patients received and the results achieved. For instance, calls to 911 dropped after health coaches helped patients program their cell-phone speed dial with a clinic's 24-hour call number.

The critical flaw in our healthcare system "is that it was never designed for the kind of patients who incur the highest costs," Gawande writes. For example, a 30-year-old with a fever might do just fine with a 20-minute visit to a doctor's office, and a pedestrian hit by a car likely will be able to find the right care in an ER. But a 40-year-old with drug and alcohol addiction or a 60-year-old with heart failure, obesity, gout, and a bad memory of his 11 drugs would not be well-served by the current system.

"It's like arriving at a major construction project," writes Gawande, "with nothing but a screwdriver and a crane."

To learn more:
- read the article abstract  (subscription required for full access)
- here's a New Yorker blog post about Atul Gawande's article