In medical emergencies, patients have few alternatives to calling 911 or rushing to the emergency department for costly care. That's the status quo, but a growing number of providers, payers and agencies are testing care approaches that help patients in novel and proactive ways.
One of these approaches is mobile, integrated healthcare. Teams made up of a mix of clinicians are available 24/7 to attend to patients' needs—outside the hospital and in person or by video chat, phone or text message, whether there's an emergency or not. Evidence suggests this approach can improve patient outcomes and lower costs, although putting it into practice presents considerable challenges.
“There is significant, potentially avoidable cost in most populations, and it can be identified if you choose to look for it,” said Dr. Eric Beck, CEO and president of Evolution Health, a population health management company that managed such a program in Florida. A preliminary study of that program, carried out among members of a Medicare Advantage PPO, was recently published by Beck and other researchers in the Journal of Health Economics and Outcomes Research.
The study showed a 19% decrease in monthly emergency room costs per patient and a 21% decrease in emergency department utilization among the roughly 1,000 patients enrolled in the model, compared to a control group. Patients also appeared to be more engaged and active in managing their health. A larger, forthcoming study will include 60,000 patients.
The program in Florida began with specifying high-risk, high-cost patients for whom interventions would most likely have an impact. The patients in the study represented between 9% and 12% of the entire Medicare Advantage membership and more than half of its costs.
Those patients received planned and unplanned care from physicians, nurses, paramedics, pharmacists, social workers and other providers. A patient with a chronic illness, for instance, would have a care plan that included coaching, appointment follow-ups and medication adherence through home visits and weekly phone calls.
Such regular contact is supposed to help patients manage chronic diseases by ensuring they receive timely preventive care. And if they do have emergencies, they can call the team.