Addressing patients' social needs could help reduce costs, ER usage, finds Commonwealth
The high-need population is older, has lower levels of education and income and includes more women and African Americans.
By focusing better on the needs of the 10 percent of patients who have two or more major chronic conditions, especially since they account for about 65 percent of the nation's healthcare expenditures, organizations can make great strides in controlling spending, according to a new study by The Commonwealth Fund.
Strategies such as patient-centered communication and enabling easier access can reduce unnecessary emergency department visits and help patients avoid delays in their care, thereby avoiding some of the factors that drive up the country's healthcare costs, the study found.
Using a survey of 3,009 U.S. adults, 1,805 of whom were considered "high-need" (having multiple chronic conditions) as a statistical basis, the study found that the high-need population is older, has lower levels of education and income and includes more women and African Americans.
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They also use healthcare services more than other adults. Nearly half were hospitalized overnight sometime during the past two years, and a similar number went to the emergency room multiple times in the same span. About one in five used the emergency room for a condition that could have been treated in a doctor's office or clinic.
Emotional distress is a big unmet social need among these kinds of patients, typically. Thirty-seven percent, according to the survey, said they often felt socially isolated, lacked companionship, felt left out or reported being isolated from others.
Access problems are also persistent across this population. About 44 percent said they had delayed their care because of a lack of transportation, limited office hours or an inability to get to an appointment quickly enough. Just 35 percent of high-need patients said it was "somewhat" or "very" easy to get after-hours medical care without dropping by the ER, compared to more than half of other adults.
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Patient-centered communication, defined by the report as listening carefully and involving the patient in decisions, is critical to high-quality care for the high-need set. They generally report that their providers don't specifically involve them in treatment decisions.
Enacting those strategies, as well as providing same-day answers to medical questions, is associated with lower rates of non-urgent ER visits, the report found. And having accessible after-hours care is associated with less frequent ER usage regardless of urgency.
The Commonwealth fund recommends implementing these strategies, and more actively addressing patients' social needs, as a means of reducing waste and unnecessarily high costs.
Twitter: @JELagasse
