When health innovation leads to personalization, care costs drop

Imagine you are the adult child of Susan. She’s just been discharged from her fourth hospital stay in six months and you’re at a loss as to how to prevent the fifth. Susan has diabetes, chronic heart disease and is obese. As you are getting her settled back at home, the phone rings and on the other end is a nurse calling to introduce herself as the person who would be taking charge of your mother’s care plan from here on out.

While the call is appreciated, you know that you’ll unlikely be able to take another day off of work and you explain that you’re skeptical your mother will take the initiative to go to her follow-up appointment on her own. She assures you that this isn’t the last call that she’d be making and she’d try back in the morning to remind your mother so you wouldn’t have to. In the following weeks, the persistent nurse develops a rapport with Susan, coaching her one-on-one to manage her diabetes and improve her diet, while reinforcing the importance of taking all of her prescribed heart medications. Six months pass and you and your mother haven’t been back to the hospital since.

Susan is representative of the 20 percent of all patients who account for 80 percent of all health care costs. Insurers have taken notice of the Susans of the world. They're the patients with multiple chronic conditions. They typically have other issues in common, including a mix of behavioral health issues, and lack of family or social support. Their care is often inconsistent and uncoordinated.

The nurse accompanying Susan in her health journey is part of an innovative approach to lowering health care costs called the Intensive Medical Home (IMH.) The goal of the IMH program is to improve the quality of life for high-risk patients through better-coordinated care, in turn reducing overall costs, like avoidable hospital stays. 

The IMH approach is twofold: Physician groups reduce costs by developing detailed care plans with the patient that emphasize frequent communication and the insurer — in this case, Blue Cross and Blue Shield of Illinois (BCBSIL) — funds a high-touch nurse dedicated solely to these patients. Nurses are employed by the physician practice, and educate high-risk patients on how to self-manage their chronic conditions.

Most patients never know they're being cared for differently, but they come to appreciate the IMH approach because it offers rapid access to their care team and an emphasis on more personal attention. When doctors and nurses coordinate their interactions and involve specialists like behavioral health experts, the enhanced communication makes for improved care and reduced medical costs.