Focusing Care on the Highest Cost Patients

Submitted by jonpearce on Mon, 2011-02-21 08:26

Atul Gawande, the author of "The Checklist Manifesto" and "Better", has an interesting article in the January 24 issue of The New Yorker ( on efforts to target healthcare services to the small number of patients who consume the greatest amount of healthcare resources.  These patients, often having multiple chronic diseases, often slip through the cracks of the conventional healthcare system and end up using resources such as emergency rooms or inpatient services that are inefficient and extremely expensive.  Gawande describes efforts by primary care physician in Camden New Jersey to target these patients and provide focused medical care and other services that dramatically improve the health status of these patients, with significant reduction in the cost of their treatment.  He also describes specialized clinics that have been established in the Atlantic City area as a joint venture of the casino workers union and Atlantic City Medical Center to treat patients with chronic conditions.
Healthcare analytics plays a key role in these processes by identifying these types of patients, assessing their common characteristics and developing effective protocols and processes for their treatment.  Using data obtained from medical claims, laboratory results and other sources, patients with chronic diseases who are high utilizers of high-cost services can be targeted and analyzed separately from the rest of the population.  These techniques are especially useful in analyzing  emergency room utilization, separating true emergencies for patients who use the emergency room because of ineffective alternative sources of care. For accountable care organizations, employers and and others who take population based health risk, this is a useful and informative article.