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Reduce Your Chronic Care Community and Chronic Costs

 |  By kminich-pourshadi@healthleadersmedia.com  
   October 03, 2011

Here's a statistic to make you feel ill: In the relentless upward march of U.S. healthcare spending, almost two-thirds (63%) goes to just 10% of patients, and nearly half (52.5%) is spent on 5% of patients, according to a recent study from the National Institute for Health Care Management.

Who are these high spenders? Increasingly, and not surprisingly, they are chronic care patients. This trend should be a call to action for healthcare financial leaders: this is where you should invest dollars now to prevent future losses in reimbursements. Chronic care patients were a money-maker under volume incentives, but they will be a drain to the bottom line when pay-for-performance and new readmission rate standards take hold.

At HealthLeaders' recent CFO Exchange event in La Jolla, CA, healthcare financial leaders agreed that their budgets will require deep cuts – as much as 20% – over the next few years. Doing so means going beyond the low-hanging fruit of efficiencies. Healthcare leaders must implement programs that address areas of greatest potential reimbursement loss under the Patient Protection and Affordable Care Act. Chronic care, with all its costs and complexity, is a great place to start.
How many chronic care patients are treated at your hospital today, and how many are likely to be enter your facilities in the future? Medicare will cease paying for 30-day readmissions. The chronic care patient has a proclivity to land in that category.

There is no shortage of pilot programs addressing chronic care populations, and the medical home concept, which incorporates a model for chronic care, is spreading rapidly. In the September edition of HealthLeaders magazine, I look at some innovative approaches group practices are taking for chronic care, as well as how medical homes can make margin.

Yet treating chronic care patients is a losing battle, in a sense. Wouldn't it be wiser to stop the problem before it happens? This is the line of thinking behind an innovative program launched by Ochsner Health System, an eight-hospital, nonprofit, academic healthcare system based in New Orleans.

Change the Kids, Change the Future aims to transform the health and wellness of the local community, starting with kids and using schools as the focal point. Based on research showing that chronic health problems such as diabetes, obesity, and hypertension stem primarily from lifestyle choices, Ochsner decided to put resources into attacking the problem at its root. Change the Kids, Change the Future helps educate students about how their lifestyle choices have a long-term impact on their health.

Ochsner chose a local school with health and population demographics typical of the average schools in this country. That meant some students receive public assistance, which is significant for health indicators; low-income individuals tend to be at higher risk for many chronic care diseases. Ochsner then engaged school administrators, students, teachers, families, and even the local grocery store to teach students about nutrition and cooking, fitness, and preventive health behaviors.

"We realized we needed to work with the whole family, because when these kids get home they don't have control of the menu. We could help the school offer better [food] choices, but we needed to get the family involved if we were going to make a total change," says Patrick J. Quinlan, MD, CEO of Ochsner Health System. "Often these kids can be change agents at home. Parents want to help; they are just doing what they do because that's all they know."

Ochsner provides the schools with a nurse practitioner and a mobile exercise van. But much of the labor involved to set up and run the program was donated by hospital workers eager to see the community get healthier. They worked with students to educate them and create a student wellness committee. The hospital also set up partnerships with businesses that could influence the success of the endeavor, including the grocery store, which agreed to put up signs on its shelves indicating healthy food choices.

It will take years to truly quantify how Change the Kids, Change the Future reduces the chronic care population in New Orleans. But Ochsner has the national healthcare system in mind. "These days we are all so focused eliminating cost. If you're worried about cost, there's nothing cheaper than a healthy person," Quinlan says. "Since these are problems hospitals are dealing with nationally, we set out to create a program that could be emulated on scale."

That's good for patients and CFOs alike. Financial leaders should guide their organizations toward investing in programs like Ochsner's, which address chronic care and the bottom line.

Karen Minich-Pourshadi is a Senior Editor with HealthLeaders Media.
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