The story of providing healthcare for high-need populations is a troubled one. Despite many years of legislative attempts to lower the cost of health insurance, the cost of healthcare in the United States has seen a dramatic rise, outstripping the rate of median income growth. The way costs have been increasing, health insurance may soon be too expensive for the average household to afford — by one estimate, premium costs will surpass median income by 2033. For many high-need individuals, health insurance is already beyond reach.
For those tasked with the responsibility of providing healthcare for those who need it most, the situation may seem desperate. But there is good news.
Across the country, regional- and state-level health organizations have been identifying ways to provide quality care for their people at lower costs. By tackling the issue from the bottom up, these organizations have identified ways of lowering the cost of healthcare.
On the West Coast, where the cost of living has become notoriously expensive, The Oregon Healthcare Quality Corporation, also known as Q Corp, sought to help offset the costs of healthcare by simply aggregating information. Q Corp brought together subject matter experts and a number of partners to gather data regarding the cost and quality of healthcare, which was then compiled into a single report. For example, their 2015 Clinic Comparisons Report compiled cost and quality data for over 150 clinics, raking them in a continuum from lowest to highest quality and lowest to highest cost. Their report, and subsequent reports that they continually release, have begun to be used by primary care practices in making referrals and treatment plans, lowering costs indirectly by referring patients to less expensive options of comparable quality.
The Oregon Health Authority is another player on this scene. The group is taking a more proactive approach to lowering healthcare costs entirely outside of the hospital or the clinic by focusing on 18 preventative healthcare measures. In an example cited by Modern Healthcare, one measure involves tracking who among their Medicaid population is a smoker. They then focus on working to help that group quit smoking. Similar measures find ways to help identify early and prevent eventual chronic and expensive health problems from developing to begin with. Improving the overall health of their Medicaid patients helps alleviate both the financial and resource burden that would otherwise be spent on them.
Organizations in Humboldt County, California likewise found a way to lessen the burden of healthcare costs. The area houses a formidable number of high-needs “super-utilizers,” many of whom are homeless and suffer from serious, chronic mental and/or physical conditions that skyrocket their healthcare costs, many of whom are dependent on MediCal (California’s Medicaid program). These individuals would often find themselves in different clinics and hospitals, sometimes repeating or undergoing unnecessary medical procedures simply because their information was not shared between healthcare facilities, creating a drain on available resources and taxpayer money. To remedy this situation, the North Coast Health Improvement and Information Network teamed up with the County Department of Health and Human Services to create a system that would alert case managers whenever a “super-utilizer” was in contact with a healthcare facility, ensuring that the facility was up-to-date on the client’s records and did not provide or perform unnecessary treatment or aid. This system, by engaging directly with the clients, developed a consent process that made sense for the clients and enabled their information to be shared.
These are just a few examples in one part of the country. Nationwide, communities are finding innovative ways of reducing the cost of healthcare by working to help those individuals who are most in need. They are finding ways of eliminating unnecessary expenditures and wasteful allocation of resources. They’re finding ways of uniting local partners to find local solutions. Even if there never is a single nation-wide legislative solution to the issues facing healthcare in America, there are ways available to us now to help make healthcare affordable and our communities healthier.
Modern Healthcare, “Oregon Agency Creates Measures for Health outside of Clinic Walls.” http://www.modernhealthcare.com/article/20171111/NEWS/171119988
HealthAffairs, “The Road to Affordability: How Collaborating at the Community Level Can Reduce Costs, Improve Care, and Spread Best Practices.” https://www.healthaffairs.org/do/10.1377/hblog20171108.983176/full/
Oregon Health Care Quality Corporation, “Cost of Care.” http://q-corp.org/our-work/costofcare