Unnecessary hospital admissions are a huge drain on the nation’s healthcare system with one study concluding that hospitals spent $30 billion in such visits in 2006.
To reduce the number of these preventable hospital admissions, especially in the emergency room, a Minnesota integrated healthcare provider and insurer launched a pilot plan in August 2011. HealthPartners’ plan aimed to increase access to primary care and specialty care to a small subset of patients who previously ended up seeking care in the emergency rooms. The pilot program has been a success with the number of visits between two months before the program launched and two months after falling by an eye-popping 65 percent.
The program began by identifying a small subsection of high-risk patients who repeatedly seek care in the hospital and in the ER, whereas they can be treated more appropriately in primary or specialty care. For each of the 27 patients enrolled in the program, their access to primary and specialty care was increased. At the same time, the care plan for each patient was integrated into their electronic medical records and was flagged such that providers and staff at all five HealthPartners’ hospitals and 25 medical clinics could view it.
Recognizing that many of these patients come to the hospital and ER to get access to narcotics, HealthPartners restricted their availability in all cases, except to treat medical problems unrelated to chronic pain. Patients who exhibited narcotic addiction were referred to a chemical dependency treatment plan.
As a result, in a four-month period — two months before and after HealthPartners launched the pilot program — the provider/insurer noticed a 65 percent drop in the number of preventable ER visits and hospital admissions. Two months before the rollout, ER admissions among these patients numbered 121; two months after, it was down to 53. In hospital admissions, the number fell from 57 to nine.
The reduction had a real impact on HealthPartners financials too, with an estimated cost savings of $511,000.
A Deep-dive Into Specialty Pharma
A specialty drug is a class of prescription medications used to treat complex, chronic or rare medical conditions. Although this classification was originally intended to define the treatment of rare, also termed “orphan” diseases, affecting fewer than 200,000 people in the US, more recently, specialty drugs have emerged as the cornerstone of treatment for chronic and complex diseases such as cancer, autoimmune conditions, diabetes, hepatitis C, and HIV/AIDS.
“This pilot study suggests that individual care plans can significantly improve care for this vulnerable subgroup of patients and lower healthcare costs,” said Dr. Rick Hilger, a HealthPartners hospitalist at Regions Hospital, in a news release.
Read more about the pilot program here.
