Primary Care Providers Can Lower the Cost of Healthcare

Posted by Continuum on Apr 18, 2017 11:02:00 AM

Today’s patients have numerous choices of hospitals, urgent care, and other ambulatory care centers when they seek treatment. While primary care providers (PCPs) can typically help patients with these decisions, patients sometimes visit these facilities before consulting their PCPs for treatment or preventative care. Expensive hospital visits can drive up healthcare costs and have a negative impact on quality overall—but fortunately, PCPs have some options to help keep costs down. 

PCPs lower healthcare utilization

Independent PCPs emphasize quality of care through their personalized interactions and relationships with their patients. When PCPs are readily available in a community, patients are less likely to seek treatment at a specialized facility, hospital, or urgent care center.1 Unnecessary emergency room visits are a drain on the nation’s healthcare system when the source of the visit could have been treated or prevented by a primary care provider.

PCPs focus on establishing a rapport with their entire patient population. These relationships allow doctors to draw conclusions about a patient’s overall health or potential illnesses on an ongoing basis. Consistent, meaningful visits build a bond between patient and provider, which encourages the patient to seek treatment from his or her PCP over a hospital physician.

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Topics: cost of care, lower cost of care, independent physician, hospital employment, Primary Care Providers

High Risk vs. Rising Risk Patients: Knowing the Difference Could Save Your ACO Money

Posted by Continuum on Mar 15, 2016 11:00:00 AM

It is well documented that 5% of the population account for 50% of healthcare spend.1 Provider organizations, such as ACOs, often focus expensive complex care management resources on this patient population segment, often referred to as “high-risk” patients. While conventional wisdom supports the approach, a subcategory of “rising risk” patients may represent an even greater opportunity to drive quality and lower the overall cost of care.

Understanding the Difference

Complex care management involves multi-disciplinary, licensed staff who coordinate closely with primary care teams to meet the needs of a practice’s high-risk patients. Selected cohorts may include patients with multiple co-morbidities, selected transitions of care and/or Emergency Department (ED) over-utilization. A complex care management program might also include high-risk patients within certain medication-focused or demographic categories. Such patients are often “high touch,” requiring both face-to-face and telephonic support, and have had numerous acute care episodes and/or high utilization of multiple resources. Keep in mind that while preventing additional acute episodes is important to prevent additional spend, the cost incurred has already occurred and cannot be altered. 

Once identified, care coordinators proactively ensure that these patients receive the right care, at the right place, at the right time using predictive analytics, customized care plans, point-of-care decision-support tools embedded within an EHR, and access to a high quality/high value provider network. While larger provider organizations may be able to support embedded care coordinators, most groups find that a centralized care coordination team serving multiple providers is far more cost-efficient.

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Topics: Coordinated Care, high risk patients, at-risk patients, cost of care, care coordination, ACO

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