Disease Management Not Enough To Curb Health Care Costs, Study Finds
Only about 10% of costs associated with the costliest Medicare beneficiaries were related to preventable emergency department visits and hospitalizations, according to a study published Monday in the Journal of the American Medical Association, Modern Healthcare reports. The study suggested that the U.S. must go beyond disease management and instead look at improving population health and hospital efficiency to slow health care spending.
For the study, researchers at Harvard University examined emergency department and hospital costs for Medicare beneficiaries whose costs ranked in the top 10%. The researchers excluded from their sample Medicare beneficiaries who were younger than age 65, those participating in Medicare managed care and individuals who died during the year (Evans, Modern Healthcare, 6/24). In total, the researchers determined that 113,341 Medicare beneficiaries from their overall sample of 1,114,469 Medicare beneficiaries qualified as "high-cost" patients.
The researchers found that the costliest Medicare beneficiaries were more likely to be:
- Slightly older than the average beneficiary;
- Black; and
- Suffering from comorbid illnesses, including heart failure, diabetes and cancer, as well as mental illnesses and substance use disorders.
In addition, the researchers determined that high-cost Medicare beneficiaries accounted for:
- 79% of Medicare's inpatients costs in 2010;
- 73% of acute care spending;
- 56.7% of hospital admissions;
- 32.9% of ED costs; and
- 30.8% of ED visits not resulting in hospitalizations.
After comparing high-cost and non-high-cost Medicare beneficiaries, the researchers found that:
- 42.6% of ED visits among high-cost beneficiaries were preventable, compared with 44.2% among non-high-cost beneficiaries;
- 41% of treatment costs among high-cost beneficiaries were for preventable ED visits, compared with 42.6% among non-high-cost beneficiaries;
- 10% of combined ED and inpatient costs among high-cost beneficiaries were preventable, compared with 19.1% among non-high-cost beneficiaries; and
- 9.6% of hospital costs among high-cost beneficiaries were preventable, compared with 16.8% among non-high-cost beneficiaries.
The researchers also determined that regions with more primary care physicians had more preventable costs and higher per capita preventable costs (Petrochko, MedPage Today, 6/24).Â
Researchers Urge Alternative Savings Methods
The researchers wrote that the "findings suggest that strategies focused on enhanced outpatient management of chronic disease, while critically important, may not be focused on the biggest and most expensive problems plaguing Medicare's high-cost patients."
Karen Joynt -- study author, health policy professor at Harvard University's School of Public Health and a cardiologist with the Department of Veterans Affairs and Brigham & Women's Hospital -- said the results show that hospitals and policymakers should not just focus on disease management, but also implement other strategies such as population health and hospital efficiency to curb overall health costs. For example, the study recommended hospitals "additionally focus on reducing per-episode costs for high-cost disease entities through clinical innovation and care delivery redesign," since disease management itself might only deliver smaller savings (Modern Healthcare, 6/24).
In an accompanying editorial, Aaron Carroll of Indiana University School of Medicine and Austin Frakt of Boston University School of Medicine wrote that the study did not discourage efforts to reduce preventable inpatient and ED costs, but rather recommended those efforts be applied more efficiently by not using high-intensity and capacity-constrained care on those with preventable conditions (MedPage Today, 6/24).This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.