The two most important numbers in the American healthcare system are 5 and 50, writes Ezra Klein in a recent article in The Washington Post. What Mr. Klein is referring to is the fact that five percent of the population accounts for about 50 percent of the American healthcare system’s spending. Mr. Klein details it further, stating that the health problems of 15 million Americans consume one-tenth of the United States’ overall gross domestic product (GDP).
The 5% is comprised of those who are chronically ill. They are often the underserved that are “frequent flyers” in our emergency departments and admitted in our hospitals. They require an enormous amount of resources from hospitals, physicians, nurses and staff – both financial and labor. Often, the problems that require frequent trips to the emergency department are not new diagnoses, rather the poor management of existing conditions such as diabetes, congestive heart failure and asthma.
Nearly two years ago, Ellis Medicine partnered with the Visiting Nurse Service of Northeastern New York and many community agencies to create Care Central. Care Central aims to help those who have limited access to healthcare services and to be a centralized location for community support services. One aspect of Care Central is it Chronic Care Team, which works with many of the aforementioned “frequent flyers” to help them gain access to the medications they need to prevent complications and to connect them with community services to help manage their conditions.
Mr. Klein also states that the problem with the 5% isn’t that they aren’t necessarily extremely sick; instead, it’s that they have obstacles to accessing care and are often difficult to find in the system. That’s where Care Central steps in – to connect these patients with the services they need.
When patients arrive in the emergency department, they are identified as those who could benefit from having the help of Care Central to help manage their care outside of the hospital. Our Care Central team of registered nurses, social workers and support staff visit patients while they are in the hospital to introduce themselves and their services. The team continues to assist the patient when they leave the hospital and return home, helping them coordinate their follow-up appointments or connect with the services they need to keep them well in their own homes and/or keep their chronic conditions from getting worse.
Ellis Medicine’s investment in Care Central is similar to that of a research and development expense. Ellis does not receive an economic incentive for its efforts in Care Central; instead, Ellis loses revenue on the inpatient side if Care Central is successful in its mission – to keep the chronically ill out of the hospital. So why has Ellis invested so heavily in a program that ultimately reduces its revenue? The answer is simple – it is the right thing to do for our community.
Care Central is still evolving to meet the needs of the community and provide the right services to the right people in the right places. The success of Care Central will ultimately be realized if the “frequent flyers” access the emergency department less than they have before and become healthier in their own homes. We need to help bridge the gap between 5% and 50% not only for the overall financial health of our country, but most importantly, to help those in greatest need of our assistance in accessing high quality healthcare.
If you are interested in reading more, please check the links below:
Getting to the root of the problem
By Steven Ross Johnson
If this was a pill, you'd do anything to get it
By Ezra Klein
Changes in healthcare like the Affordable Care Act will make it necessary to practice population-based care