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“The Hot Spotters”: Is Better Care For The Neediest Patients The Answer To Lower Healthcare Costs?

Author-physician Dr. Atul Gawande has done it again with a well-written article in The New Yorker magazine entitled, “The Hot Spotters.” It deals with the fact that 5 percent of people with chronic illness make up over 50 percent of all healthcare costs.

If we can zero in on providing better preventive care for those people, we can finally get our arms around runaway healthcare costs. How great that you don’t even have to have a New Yorker subscription to read it. Here are a few cliff notes until you get to it:

– In Camden, New Jersey, one percent of patients account for one-third of the city’s medical costs. By just focusing attention on the social and medical outpatient needs of those people, they not only got healthier but costs were cut in half.

– Our current system is unable to reign in costs. We need to completely re-design and fund how we do primary care.

– Charging high co-payments to people with health problems just backfires. They avoid preventive care and end up hospitalized with expensive and life-threatening illnesses that are much worse and more costly.

– Our current system is not designed for patients with complex medical problems who incur high costs. The patient with heart failure, obesity, gout and on eleven different medicines needs a different kind of care than the traditional emergency room, hospital, and multiple specialists handling one specific organ. That patient needs care coordination.

– Doctors are financially penalized for providing care coordination.

– The healthcare system is designed to say “no.” We need to shift into a mindset that says “yes,” and really understands the patient’s need at that moment.

– To bring the cost of healthcare down, we need less hospital beds. The more healthcare services in an area, the higher the cost. Preventive and comprehensive care means less expensive (hospital) care.

– Medical companies, hospitals, and specialists profiting from the excess of scans and procedures will get squeezed. This will provoke retaliation, counter-campaigns, and intense lobbying for Washington to obstruct healthcare reform. It is already happening.

– For every dollar spent in school districts to finance smaller class sizes and better teachers’ pay, that money was diverted instead to covering rising healthcare costs. For every dollar, the cost of maintaining teachers’ health benefits took a dollar and forty cents.

– High-touch healthcare will face the obstruction of lobbies that want to keep the status quo. 

These notes don’t do the article justice. Take some time and read it, and learn how we can do things differently.

*This blog post was originally published at EverythingHealth*


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One Response to ““The Hot Spotters”: Is Better Care For The Neediest Patients The Answer To Lower Healthcare Costs?”

  1. Toni,
    Thanks for writing on the New Yorker piece. I agree, it’s an instructive article: It shows that by taking care of chronically ill people’s non-emergent health care needs, we can reduce hospital admissions, save money and improve their health. Or at least that the approach worked in Camden, NJ, with a group of highly-motivated providers who were open to changing the status quo.

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