As we move toward a system of value-based care where the focus is on high quality, cost-effective care of populations, payors are setting rates per member per month that are designed to maximize the preventive health aspects of a care team rather than the costs of acute illnesses. Yet nowhere are preventive strategies more needed and yet often neglected due to more acute illnesses that arise than in children with medical complexity (CMC).
When 62-year-old Rod Larson of Minneapolis was found to have a rapidly worsening bacterial skin infection, his primary care doctor immediately sent him to the hospital.
On arrival, Larson was put in a room and examined by a physician assistant. He didn’t stop at the admissions office because his information and treatment orders already had been placed into the hospital computer system.
More specifically, who coordinates the proliferating number of health care helpers variously known as case managers, care managers, care coordinators, patient navigators or facilitators, health coaches or even — here’s a new one — “pathfinders”?
Rachel Schwartz, a licensed clinical social worker for close to 20 years, came face to face with this quandary earlier this month. Employed by a home care agency in Virginia, she visited a woman in her late 70s who had recently come home from the hospital.
Virginnia Schock seemed headed for a health crisis. She was 64 years old, had poorly controlled diabetes, a wound on her foot and a cast on her broken wrist. She didn’t drive, so getting to the people who could tend to her ailments was complicated and expensive. She had stopped taking her diabetes pills months before and was reluctant to use insulin; she was afraid of needles and was worried that a friend’s son, a drug addict, might use her syringes to inject them.
Primary care physicians stand to earn additional revenue starting Jan. 1 under Medicare's new fee schedule for care coordination of chronically ill patients and for using certain telehealth services.
To bill for the $40.40 per member per month fee, physicians must offer some type of 24/7 access, a minimum of 20 minutes per month of clinical team time, a creation of care plan, coordinate community-based services and agree to manage hospital, emergency department and home care services.
New Jersey taxpayers could save hundreds of millions of dollars a year and thousands of patients could have improved health and better quality of life if clinicians coordinated physical and mental health care, a new Rutgers University study says.
The report, produced by the Center for State Health Policy, found that more than a third of the $880 million in hospitalization costs in the 13 communities it studied were associated with behavioral health issues such as mental health disorders and substance use.
Primary care is the key to lowering health care spending. That’s the conclusion of a new study released Sept. 30 by the UnitedHealth Center for Health Reform & Modernization. The challenge for policymakers, medical providers and other health care stakeholders: Unlocking the hidden value in primary care will require expanding primary care capacity and changing the way care providers are paid.
A recent study described 60 persons who returned to an emergency department (ED) within 9 days after being discharged from it. (The study, "Return Visits to the Emergency Department: the Patient Perspective," was published online on September 2, 2014, in Annals of Emergency Medicine.)
In most cases, that subsequent ED visit was a quest for follow-up care for the condition that had originally brought the person to the ED. Most of these patients did report having a primary-care provider they could have consulted instead.
Phoenix obstetrician Megan Cheney no longer makes hours of telephone calls on Thursday nights to report routine results of laboratory tests to waiting patients. The calls, however, still get made every week.
