HL20: Richard Merkin, MD—Competing to Convert Care Dollars Into Cure Dollars

Unnecessary care, like beauty, is sometimes in the eye of the beholder. To Merkin, telltale signs include patients who skip medications, or those living alone, who might end up going to an emergency room on the weekend, where the ED physicians might not have those patients' medical history, and if overly cautious, might run extra tests and admit patients for overnight observation.

The more such inefficient care can be found, healthcare providers can reallocate resources to call those patients on a daily or weekly basis and preclude some of that unnecessary care.

"Sometimes we have what we call high-risk physicians, who might only have 100 or 150 patients in their practice," Merkin says. "These would be all either complicated medically, socially, or suffering from mental illness." Such physicians could reach out to the patients, even giving patients their home number or a cell phone and saying to call any time. "It's almost like a concierge type of medicine, and just by having access to a doctor more often, and the doctor being more part of that person's life, we've noticed that hospitalizations, which is the most expensive portion of healthcare today in America, have come down considerably."

Insurance companies have tried to figure out how to predict readmissions for years, but "they haven't necessarily included mathematicians and sophisticated data miners," Merkin says. "They may be able to identify a very small percentage of high-risk patients."