Healthcare today continues to shift from traditional fee for service to value-based delivery models. Healthcare consolidation also continues throughout the United States with goals to decrease costs, increase accessibility for patients, improve outcomes and quality. The shift has required a more patient-centric, data driven approach and a healthcare system focused on prevention and disease management.
What further complicates this or rather, acts as a key driver for this change is…the “silver tsunami”.
Figure 1: U.S. Census Bureau Forecast
In 2016, The Congressional Budget Office (CBO) reported that about 10,000 people were enrolling into Medicare daily. In 2018, there were 59.7 million Medicare beneficiaries (Centers for Medicare and Medicaid Services). National health spending is projected to grow at an average rate of 5.5% per year for 2018-27 and to reach nearly $6.0 trillion by 2027 (National Health Expenditure Projections 2018-2027).
Figure 2: Medicare Enrollment Statistics (Centers for Medicaid and Medicare Services)
The elderly population generally requires more care, and more expensive care than other populations. The National Institute of Healthcare Management releases data periodically regarding the consumption of healthcare services. In 2014, the top 10% of healthcare spenders accounted for two-thirds of all spending. Factor in the need for more prescription drugs and the fact that Americans are living longer and the growing prevalence of chronic diseases like heart disease and diabetes, and the overall costs grow exponentially. You must weigh that stat against two other stats to truly appreciate the economic gravitas:
- As of April 2019, there are roughly 129 million American workers working full time.
- The CDC reports an overall decline in births as it relates to the total population.
The U.S. Healthcare system is strained now more than ever. The burden and responsibility to support Medicare and our aging seniors will continue to stress working age Americans.
Under value-based payment models, physicians and hospitals are rewarded for their ability to better coordinate and manage the care of a given population. Healthcare technology (and data) is a key solution to providing overall better care coordination for at risk populations, particularly those that use the ER frequently, the elderly and the chronically ill. Streamlined and coordinated care and messaging about a patient’s care often begins in the Emergency Room.
U.S. Emergency Department Statistics, Centers for Disease Control, 2016.
● Number of visits: 145.6 million
● Number of injury-related visits: 42.2 million
● Number of visits per 100 persons: 45.8
● Number of ED visits resulting in hospital admission: 12.6 million
● Number of ED visits resulting in admission to critical care unit: 2.2 million
● Percent of visits resulting in hospital admission: 8.7%
● Percent of visits resulting in transfer to a different (psychiatric or other) hospital: 2.7%
Triaging patients and coordinating care from the moment the patient enters the Emergency Room is fundamental to the care management process.
Hospitals that implemented first generation secure communication and care coordination solutions in order to “check the box” for compliance are now finding those solutions to be ineffective in meeting the patient demands and specific workflow demands of today’s healthcare teams.
MEDarchon’s secure messaging and care coordination platform, QUARC, has shown benefit and positive outcomes throughout a patient’s stay.
● QUARC streamlines patient triage by quickly identifying who’s covering which departments (for example; psychiatry consults, radiology, admission consults).
● In a recent client study, QUARC reduced overall paging to hospitalists, a key driver of patient care, by 52% within the first three months.
Patient Admission and Stay
● QUARC’s patented, intelligent routing and escalation eliminates unnecessary interruptions to clinical workflows; easing stress and the risk of burnout (reduction in pages and redundant calls to providers).
● QUARC streamlines care communications by quickly identifying who’s covering which patients and departments. This is especially useful for identifying coverage for ancillary departments (i.e.: pharmacy, laboratory, radiology, and physical therapy services).
● QUARC is proven to reduce response times for patient requests.
● QUARC eliminates unnecessary overhead paging and overall reduces noise; creating an environment for patient comfort and healing.
● A recent QUARC hospital client reports reducing length of stay by a half to one full day due to streamlined interdisciplinary team communication.
● Other studies have shown a 10-20% reduction in length of stay with up to a 30% reduction in Medicare HMO lengths of stay for medical hospitalizations.
● QUARC improves the interdisciplinary team process resulting in overall provider satisfaction.
● QUARC streamlines care communications by quickly identifying who’s covering which patients and departments. This eliminates the page – call – wait loop for hospital discharge planners.
Hospital readmissions are costly. Readmissions totaled $7 billion in aggregate hospital costs for four high-volume conditions: acute myocardial infarction (AMI), heart failure (HF), chronic obstructive pulmonary disease (COPD), and pneumonia. Case management is an effective means for reducing recurrent ED visits by frequent users. “As a result of decreased ED visits, case management also was shown to reduce cost, length of stay, and utilization of testing – both in the ED and the inpatient setting.”2
Inadequate care coordination, including insufficiently managing care transitions, has been estimated to account for $25 to $45 billion in wasteful spending through avoidable complications and unnecessary hospital readmissions.3 To reduce readmission rates, hospitals must improve the effectiveness of transitions of care, including addressing breakdowns in communication, and improving patient education and clinician accountability.4
MEDarchon is looking closely at the correlation of care team collaboration via QUARC to the readmission rates of specific patient populations (by diagnosis, payer, age, gender). Preliminary results are positive and show an overall reduction in readmission rates due to the overall better coordination of care and communication regarding discharge and aftercare planning.
1. Fingar, K. & Washington, R. (2015). Trends in hospital readmissions for four high-volume conditions, 2009-2013, HCUP statistical brief #196. Agency for Healthcare Research and Quality.
2. Grover M.D, Casey A. “Case Management Reduces Length of Stay, Charges, and Testing in Emergency Department Frequent Users” Journal of Emergency Medicine, 2018 Mar; 19(2): 238–244.
3. Health Affairs Health Policy Brief. (2012). Improving care transitions.
4. The Joint Commission. (2012). Transitions of care: The need for a more effective approach to continuing patient care.
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