Healthcare is now one of the highest costs of the U.S. economy. The country is expected to spend a projected $4.7 trillion (18 percent of the national economy) on healthcare alone in 2023.
And according to a recent study by Accenture, health literacy may be playing a significant role. The study found that each year, unnecessary emergency department (ED) visits among people with lower health literacy result in more than $47 billion in avoidable medical spending.
Nearly 36 percent of U.S. adults have low health literacy, with even worse rates found among those with lower incomes and who are eligible for Medicaid. These individuals have greater health care usage and higher costs vs those with more proficient health literacy levels. Low health literacy is estimated to cost the country about $236 billion annually. (Source: 1. J. Vernon, A. Trujillo, S. Rosenbaum, and B. DeBuono. Low Health Literacy: Implications for National Health Policy. University of Connecticut, 2007.).
Access to care is a compounding factor as well, especially for individuals in remote areas and for those with mental and/or behavioral health needs. (This is part of why CMS has pushed for the expansion of these services with its new Making Care Primary Model).
Considering these factors, could a collaborative care approach that begins earlier be the key to reducing healthcare costs and improving overall health and quality of life?
Making the Case for Collaborative Care
To have the greatest impact, a collaborative care approach begins at the earliest point possible – with preventive care tactics – and continues throughout the lifecycle of every individual.
Collaborative care should help payers and providers get ahead of more complex health conditions that result in high-cost care services and unnecessary ED visits.
An article in Managed Healthcare Executive provides a fantastic example of how a collaborative care approach can help evaluate and intervene with individuals before they reach the stage of needing an ED visit.
The article cites an example of a man with type 2 diabetes, a history of coronary artery disease, and gout, who is now experiencing knee pain following a fall two weeks ago. Ordinarily, the man would have a family member take him to the ED to be checked out. Instead, in this case, the man uses his health plan’s 24/7 nurse triage line to determine care needs and is then assisted via an at-home evaluation. It’s determined he simply needs anti-inflammatory medication and a follow-up with his primary care physician. The article authors, Cheryl Dalton-Norman, MBA, BSN, RN. and David J. Muzina, MD, MBA say the following after the scenario closes:
“In this scenario, three key stakeholders collaborated to avoid an unnecessary ED visit and the associated expense: the health plan, a nurse-first triage service, and an on-demand, ambulatory acute care and internal medicine team capable of providing 60–70% of traditional ED and urgent care services in the comfort of a patient’s home. In Ohio, this two-year-old model has helped 50% to 60% of patients seen by an ambulatory team avoid a trip to the ED. It has also delivered patient satisfaction rates higher than 95% while saving money for patients, hospitals, health plans, and employers.”
The Clear Benefits of Collaborative Care
A collaborative care approach offers numerous benefits to healthcare payers, providers, and patients (members) across the board.
The following are just 10 of the benefits of using a collaborative care approach:
- Reduce unnecessary emergency department visits
- Enable more accurate care decisions and tailored care plans
- Leverage more preventive/early-stage care tactics that are lower cost to patients/members and payers
- Empower care management platforms to be more effective in the automated identification of at-risk members in need of intervention
- Reduce or eliminate unnecessary care services or items
- Improve health literacy levels
- Increase self-activation among members for more proactive involvement in their own health
- Get a head of complex chronic conditions to prevent compounding issues and more costly services/care, and to improve members’ health
- Improve members’ health and quality of life
- Deliver better patient/member satisfaction rates
The Three Elements Key to a Collaborative Care Model
Reducing healthcare costs and improving health outcomes with a collaborative approach begins with identifying the right first touch and ensuring the patient receives the right care, from the right provider, at the right time.
As we saw in the example from the Managed Healthcare Executive, the choice to have a nurse first triage the patient virtually to determine care need/severity allowed the provider to make smarter, more cost-effective decisions for the patient, that provided high-quality, accurate, and lower-cost treatment.
But what does it take to launch a successful collaborative model? Three things.
1. Connecting collaborative care efforts to your population health model
The biggest challenge many payors face today is connecting their care ecosystem properly. This means making sure the providers and specialists, hospital systems, and other entity systems (such as those regulating claims or program rules) can be connected in a way that captures/shares the necessary health information and provides easy next-step action abilities to seamlessly transition a patient/member to the next care service/item.
The right model will support the ability to identify care challenges and help care teams proactively address them. For example, in HELIOS, configured rules engine, workflows, and criteria are leveraged to analyze data for a member/patient that then flag specific care risks or gaps needing intervention. These configured elements work together to automatically trigger notifications, automated assessments, and/or assign tasks to care managers for the at-risk member/patient so that preventive action can be taken. (HELIOS specifically has an entire library of out-of-the-box clinical workflows that get utilized in the platform to help quickly push members through to identify the right next-step tasks, assessments, or care services needed.) This intelligent automation ensures members are properly, quickly and accurately cared for while employing a preventive care approach that helps to lower costs and improve health outcomes while streamlining things for care teams so they can more quickly attend to members.
2. Capturing data across every care setting for uniform patient/member views
As mentioned above, HELIOS can act as a centralized care ecosystem repository for care teams and providers across the ecosystem. By capturing disparate data sets and integrating them within the system, HELIOS allows payers to collect data across every care setting (even from remote patient monitoring devices) and provide real-time member health views. Information is automatically updated and evolved as new data sets are added, and member’s care plans can be automatically updated (or recommended to be updated) as well.
The takeaway? Data is the connective tissue between each section of a payor’s care ecosystem, and it needs to flow and translate in a way that it’s understandable and actionable for a provider, a care team lead, a payor, a regulatory body, and the member.
3. Matching the right care service to the right provider at the right time
Pairing members/patients with the right provider and service at the right time helps establish and maintain trust and satisfaction. This also helps to engage patients/members in their health and to feel like they can trust the decisions and care recommendations (and thus be more likely to adhere to them).
The example above is again a great one – instead of an administrative assistant or scheduling receptionist, the patient is paired with a registered nurse immediately. This removes delays in care, helps the patient feel prioritized, and gets the patient to the appropriate next step faster.
A collaborative care approach requires helping to support services between providers, and HELIOS helps with this by supporting authorization and referral capabilities to help get patients/members to different providers or specialists in various care settings. And because HELIOS can do this within the platform, all the data is logged and tracked so – depending on access levels in the platform – the care manager, primary care physician, or other authorized user (nurse, utilization management lead) can see the most accurate, real-time member information immediately and at the same time, in one place. [Get more information about all the solutions in the HELIOS platform here.]
Ultimately, a successful collaborative model can help provide better care for members while lowering costs, strengthening health outcomes and satisfaction, and helping to close both critical care gaps and care access disparities.
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