More focus on high-cost patients could save $300B

In order to control the overall cost of healthcare in the U.S., stakeholders must focus on high-cost patients with chronic conditions, David Blumenthal, MD, told an audience at NEHI’s Bridging the Innovation Gap conference in Boston on Thursday.

“We’ll never make care more affordable unless we crack this nut,” said Blumenthal, who is a professor of healthcare policy at Massachusetts General Hospital/Partners Healthcare System and Harvard Medical School and the chief health information and innovation officer at Partners. 

According to Blumenthal, reducing the cost of treating 60 percent of this patient population could yield savings of $300 billion over 10 years.

“Is this enough?” he pondered. “I don’t think so, but if we don’t try to do this kind of thing, we’ll have nothing to rely on but reductions in benefits and payments to providers.”

Blumenthal highlighted five areas of focus for stakeholders:

1. Vision – Blumenthal proposed setting an aggressive target of doubling the current rate of improvement to 5 percent. “If we could double rates of improvement, we’d begin to make important measurable progress,“ he said.
2. Theory of change – Change in the U.S. does not occur from the top down, said Blumenthal. “It’s a combination of top down and bottom up action. Change has to involve millions and millions of change decisions on the part of consumers and care takers. It’s very granular change. The government can facilitate this but it can’t do it. It’s a cheerleader, not the action taker. It should, however, never make the situation worse.”
3. Community – Blumenthal believes real, systemic change will be made at the community level. “It’s the place where people receive care, where providers live and work, the place where care coordination can occur.” He said there is no one definition of community.  “It can be a neighborhood, a borough of a large city or a state,” he said. 
4. Simplification – Under the auspices of the ACA, many new government agencies were established, all of which have a stake in the healthcare delivery system, said Blumenthal. “We do too many things at the government level without asking what it means for providers and patients,” he said. “We need to ask for the impact of every new (government) program launched.”
5. Act fast – Blumenthal emphasized the need to push ahead quickly with changes to the treatment of high-cost patients. “I worry that it’s already too late,” he said, noting that the presidential election will distract stakeholders and stunt progress from being made in reducing care costs.

“The onus is on us, the people in this room and millions of others, and on our leaders (to create) a strong, well-defined, high-priority system focused on high-cost patients,” said Blumenthal.

[See also: Healthcare costs grow more slowly]

Follow HFN Editor Rene Letourneau on Twitter @ReneLetourneau.