by Leslie Small
A newly published study suggests that efforts to improve care
and lower costs associated with health care "superutilizers" —
typically patients with complex medical and social challenges —aren't always as
effective as they're heralded to be.
The subject of the study in question is the Camden Coalition of
Healthcare Providers, which convened health systems, primary care officers,
community organizations and other stakeholders in a bid to test whether
short-term, intensive care management would help reduce the cost of caring for
some of the hardest-to-treat patients after they’re discharged from the
hospital.
For the study, researchers randomly assigned 800 hospitalized
patients with medically and socially complex conditions to the Camden
Coalition's care-transition program or to usual care. Medicare was the primary
payer for 48% of the trial population, and Medicaid was the primary payer for
45% of the population. The study found that the 180-day readmission rate was
62.3% in the intervention group and 61.7% in the control group.
"I think that navigation and coordination is totally
necessary, but it's insufficient to solve the problem," says Jeffrey
Brenner, M.D., who founded the program, and is now senior vice president of
integrated health and social services at UnitedHealthcare's Community &
State division. "In many instances we found we were navigating patients to
nowhere," he adds.
Brian Castrucci, CEO of the de Beaumont Foundation, says that
the Camden Coalition experiment underscores how the health care industry is
thinking about social determinants of health in the wrong way.
While it's good that "we finally understood that there are
social conditions that impact our health," Castrucci says, "instead
of dealing with those social conditions, we're still trying to do it from an
individual basis."
"You don't clean the fish tank by focusing on the fish.
What this study has shown is that the context that people live [in] is a lot
harder to deal with than just signing them up for a social worker, referring to
housing — because when you refer someone to housing, it assumes that there is
housing for them to be placed into," he says.
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