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Better Care is the Key to Super-Utilizer Costs

Rene Letourneau, for HealthLeaders Media, March 4, 2013

"We are talking about an incredibly complex system, and part of the problem is there is a huge asymmetry in knowledge," he said. "It's much easier to figure out if you like a car than if you like a surgeon. And the sickest and most complex patients—the most expensive people—often don't have the mental faculties to be informed consumers. ... I think with the science of complexity, you have to break the problems down into small pieces and do it in a patient-centered way."

The current healthcare system makes the mistake of putting these highly complex patients through the same paces as the rest of the population, he said.

"We put them through the same process that we put everyone else through. We make them wait on hold, fight with the reception desk, and sit in the waiting room to spend just a few minutes with the primary care doctor. It is not the kind of care that the person needs. Meanwhile the American public is paying for it."

Because the care is inadequate for the complexity of their health situation, super-utilizers ultimately seek care in the ER, the most expensive care setting.

"A lot of the failures in healthcare are not clinical delivery failures," Brenner said. "They are project management problems. We need much better project management. Healthcare needs to start opening the floodgates and start hiring MBAs from other industries, who would likely shake their heads at what they would see."

One solution Brenner proposes is the uses of health coaches to follow up with high-cost patients and give them more attention, which they require to stay out of the hospital.

"A lot of work can be delegated to someone with different training and lower cost," he said. "Health coaches and navigators can be a part of the team. It makes no sense to take a highly trained nurse or doctor and have them do work that can be delegated to someone else."

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