Armed with six months of data-driven research, Regional One Health is kicking off the second phase of its partnership with nonprofit Camden Coalition in an effort to drive down costs and improve care for some its most vulnerable patients.
The number crunching will identify high-utilizers of medical services. These patients can make up to 60 to 80 visits per year. Regional One Health, the Mid-South's general hospital, estimates the three-year project will yield a $1 million per year savings once recommendations are implemented.
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“Because we get a significant volume, we had to come up with a strategy to help manage them, to understand what’s driving the cost of care so this is a broad look at uninsured patients that came to Regional One Health in the last fiscal year," said Reginald Coopwood, president and CEO at Regional One Health, a healthcare network in the Mid-South that provides accessible medical care to all regardless of insurance status. Regional One Health is anchored by the acute care hospital Regional Medical Center, located in the Memphis Medical District.
"The actual cost to take care of this population in all aspects, whether it’s inpatient, ICU, outpatient services, imaging services, is $81 million in true costs."
Data from the last 18 months revealed Regional One Health’s 25 highest utilizers.
”It’s about changing the way we think about the people who walk through our doors. We tend to think of them just as a patient. But we have to realize there is more to it; they’re really a person."
“We looked at our data (for uninsured patients). We took out all the trauma patients, birth patients, etc, and focused on our medicine emergency department. There were over 27,000 unique individuals who walked through our door and the cost of care," Coopwood explained.
"We took the top five percent across all payers — a little over 1,300 people — and it’s a cost of about $18.8 million. For our top 25 patients, it’s almost $1.5 million of cost — nurses, supplies, beds, time, blood, drugs," said Susan Cooper, chief integration officer for Regional One Health.
Regional One Health, with partner Camden Coalition, is continuing to identify the reasons why this population is making repeat visits. Longterm health issues like renal disease, sickle cell anemia, HIV and heart failure were prominent. Societal woes like mental health issues, addiction, homelessness, poverty and job loss also stood out.
“It’s to give them better care and to find out how to better manage those costs so that even if I have to spend $81 million, I’d rather spend it — instead of giving them more drugs — to put them in the right system and have them with the right social services in order to give them what they need. This is the impetus of what we’ve put together in our One Health strategy,” said Coopwood.
Online since January 11, the One Health Connect portal is now open to the public. It is a resource that provides information on medical care, food, housing, job training, legal and other social services. Community partners can create their own user groups, which can ease the tracking of referrals and follow-ups.
“We are working on offering for anyone in your agencies, online community training on how to use One Health Connect to its fullest capabilities,” said Cooper.
A 25-patient cohort will be created in April to begin approaching the care of this high-utilizers in new ways. Part of that care regimen will include data analysis to address the root causes for their frequent emergency room visits. Standardized tools will be designed to help identify gaps in care. The first cohort will be enrolled, and location visits will begin in May. Regional One Health is already engaging patients, however.
”It’s about changing the way we think about the people who walk through our doors. We tend to think of them just as a patient. But we have to realize there is more to it, they’re really a person,” said Cooper.
Dr. Jeff Brenner founded Camden Coalition 2002. A primary care physician, Brenner conducted a study of emergency room visits at his hospital in Camden, N.J. He found that a small group of patients were driving costs through emergency room visits. He then developed a model to address underlying patient issues, education, and approaches to care that has been adopted in several communities like San Diego, Phoenix, and Aurora, Co., for example.
“In order to fix complicated problems like this, you need cross-sector relationships, cross-sector data, and a new way of thinking about the problem," Brenner said.
"Then you need to have the creativity to reimagine how that system might work, and the ability to look outward at better models and innovators across the country. I feel like all those tools and all those capabilities are being built here."