March 19, 2018
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Maine hospital takes aim at most expensive patients

By Jackie Farwell, BDN Staff

When former emergency physician Lisa Letourneau thinks about wasteful health care spending, one Maine woman with a stomachache comes to mind.

The woman, who suffered from anxiety and failed to take her medication, repeatedly showed up at one of the state’s hospitals worried about her stomach pain. Hospital staff, focused on getting patients in and out quickly, kept ordering more CAT scans of the woman’s abdomen to diagnose the problem.

By the end of the year, the patient had undergone 30 scans, which typically cost at least $2,000 each and also emit radiation that poses a cancer risk.

The woman is what’s known in the health care world as a “superutilizer” — a patient who makes frequent trips to the emergency department or returns for repeated hospital stays. Those patients are considered a major factor in skyrocketing health care costs across the country.

Hospital services are often the most expensive form of treatment and can fall short in addressing many patients’ needs, particularly people with chronic illnesses.

The Robert Wood Johnson Foundation, the nation’s largest charitable organization focused on public health, has launched a nationwide campaign to identify and better care for superutilizers. The foundation recently announced Maine Quality Counts, a regional health care collaborative headed by Letourneau, as one of six recipients across the country to each receive a $200,000 grant under the initiative.

Maine Quality Counts has in turn chosen MaineGeneral Health, one of eight health care teams in the state that’s already working with the collaborative to address the neediest and most expensive patients, to take the lead on the grant. Doctors in Kennebec County will develop a model for identifying and caring for those patients that eventually will shape a statewide strategy.

Today, the woman with stomach pain is a less familiar sight at the hospital, Letourneau said. Local health workers call the woman regularly to ask if she’s taking her medication and to make sure she’s feeling well.

“It’s trying to do the right thing for people, which is often less care, and it happens to be less expensive,” Letourneau said.

While some costly medical treatments, such as for trauma or cancer patients, are unavoidable, wasteful procedures and services can be averted when health professionals at the primary care level closely oversee and coordinate patients’ treatment, she said.

“It’s all about having a relationship with somebody that you know and that you trust,” Letourneau said. “That person does the right thing for you, but no more than the right thing. It’s linked to this whole concept that the American public is gradually waking up to, which is that too much care is not a good thing either. Thirty CAT scans is not good for that woman.”

While the average American accounts for about $6,000 in health care spending a year, superutilizers can run into the hundreds of thousands of dollars and up annually, Letourneau said.

Those patients are behind an oft-quoted statistic that 20 percent of patients represent 80 percent of the country’s health care spending.

The foundation grants will help MaineGeneral and the five other health organizations to replicate the work of Dr. Jeffrey Brenner, a Camden, N.J., physician lauded for his progress with superutilizers, said Barbara Crowley, executive vice president at MaineGeneral Health.

Brenner and his team dramatically reduced hospital and ER visits among his patients by making regular home visits and encouraging patients to quit smoking and cook more, among other approaches.

The experiment led to a more than 50 percent reduction in patients’ average hospital bills.

Avoiding unnecessary hospital visits can stem from simple steps, such as getting glasses for a diabetic patient who can’t see well enough to administer her insulin shot or arranging transportation for people who can’t afford to make it to a doctor’s appointment, Crowley said.

Many of the most expensive patients also need treatment for mental and behavioral health problems, she said.

“We should work to find those individuals who — if we could provide them better care management, better navigation, better support for what their needs are — we can improve their quality, we can improve their access, and we can lower overall costs,” she said.

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