Will improving care for ‘dual eligibles’ fix the delivery system for everyone?
Helping people on Medicare and Medicaid get better care and become healthier is not poverty work, it’s healthcare design work.
Dr. Jeffrey Brenner of the Camden Coalition of Healthcare Providers manages teams that help patients with multiple health problems and complex care needs. He described the case below as average during a webinar yesterday sponsored by Reporting on Health.
This chart shows how the coalition’s work kept one person out of the hospital and reduced healthcare bills from more than $300,000 to zero. The red bar represents inpatient days and the blue bar shows emergency room visits. The drop occurs after the patient was enrolled in the coalition’s program.
Brenner said that his group started their work to improve the quality of healthcare for dual eligibles because no one is fighting over market share for more poor people.
“If I was was doing this out in the suburbs with your middle class parents, I’d have my legs cut out from under me,” he said. “We are emptying hospital beds and emergency rooms. That’s why this work is not moving as fast as it should move.”
Two market forces — a shortage of primary care doctors and an aging population — may push everyone to this model of coordinated and sometimes less care.
“All the things that our team does, aging baby boomers out in the suburbs are going to need,” Brenner said.
The coalition identifies people who often go to the emergency room and are admitted to the hospital. Care coordinators go to the patient’s bedside in the hospital and then spend the next several months helping the person with everything from emotional support to paying for medications to getting to doctor visits.
“All of our work is in the field,” he said. “We pick up patients in the hospital, visit them at home, go with them to their primary care provider and all the specialists they need.”
“Healthcare is not going to change on its own,” Brenner said. “It has to have outside pressure to change.”