Of the more than $2.8 trillion spent annually on health care in the U.S., up to a third may be classified as waste—that’s roughly $933 billion in costs resulting from mistakes, poor care coordination, and in many cases, avoidable trips to the emergency department.
Eric Beck, DO, MPH, sees much of this waste resulting from what he describes as a financial misalignment among patients, providers and payers. Dr. Beck is CEO of Evolution Health, a Dallas-based company created to cost-effectively manage the specific needs of patients with multiple chronic conditions (MCCs).
Filling in the Gaps
“Where patients receive care today is largely determined by how providers are reimbursed,” says Dr. Beck, an emergency physician. He believes the fee-for-service model created a system that leans toward acute treatments in the most expensive setting—a hospital.
“While U.S. health care is truly amazing in many ways, there would be far different possibilities if you began with the question: ‘How do we keep a population healthy?’ I’m not sure anyone seeking to solve that problem would design the system we have today.”
In addition to the expense, the current system is also badly siloed. There’s often little communication between a hospital and the patient’s usual health care team, including the primary care physician, pharmacist, and home health care providers.
Without an effective handoff, lapses in care after discharge are both predictable and costly: Between $12 to 44 billion is spent annually addressing adverse health outcomes resulting from poorly coordinated transitions from the hospital to other care settings.
This is especially problematic for patients with MCCs. “There are a lot of potential gaps for complex patients to slip through,” says Dr. Beck. “The solution is to specifically fill in these gaps to create real continuity of care for medically complex patients.”
Right care, right place, right time
Evolution Health partners with insurers and health care systems to manage care for chronically ill patients and improve clinical and financial outcomes. Its model is called mobile integrated health care (MIH). Beck describes it as “an interprofessional team approach to population health management” that is centered on patients, but led by physicians.
When a partnering hospital discharges a patient, the Evolution Health team takes over as the patient’s go-to provider for any health concerns. Services are available 24 hours a day, 7 days a week, 365 days a year.
Typically, a complex patient experiencing an acute episode will head directly to the emergency room. Patients receiving care from Evolution Health, can simply call, text or email the clinical team at any time. Rather than default to another 2 a.m. ambulance trip, the round-the-clock care team considers what resources are available in community, network or health system and determines the best fit for the immediate need.
Patients with worsening symptoms can be assessed with a home visit and/or via telemedicine. The mobile or virtual team can include a combination of physicians, pharmacists, social workers, nurses, paramedics and community health workers. Simple issues, like requests for refills, are resolved immediately over the phone.
Whatever the case, the issue can be resolved quickly and effectively by utilizing the most appropriate clinical expertise from the team. In the event of a legitimate emergency, all calls to the Evolution Health command center are fielded by nurses trained as emergency medical dispatchers, collaborating with emergency medicine physicians. If the situation warrants, they can immediately transfer the patient to the appropriate local 911 call-center, coordinating and tracking care from the transition to the emergency room, throughout an inpatient stay and eventually back home.
This flexibility is the key providing the most cost-effective and appropriate care, Beck said.
Studies vary, but up to 27 percent of emergency room visits are considered unnecessary, meaning the care could have been provided in the home or at a primary physician’s office without the expense and risk of secondary infections. This amounts to $4.4 billion in waste annually.
Evolution Health’s internal analysis found this model of care reduced emergency room visits by 21 percent and reduced inpatient care by 40 percent, while improving patient satisfaction ratings and overall health outcomes, according to Dr. Beck.