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Study: “One-Stop Shopping” Cuts Hospital Costs by Double Digits in Older Patients

Harvard panel hears about person-centered approaches to care

The per-patient cost of hospital care declined 19.4% for aging patients enrolled in a project that provided home-based services, according to a report from HealthLeaders Media. Now an interdisciplinary panel is examining ways to build and pay for a “critical pathway to improved care.”

When seriously ill patients seek care at the MedStar Washington Hospital Center in Washington, D.C., they can expect to receive care from the system for the rest of their lives––not just health care, but everything required to meet their social and functional needs, said Dr. K. Eric De Jonge, MedStar’s director of geriatrics. He calls it “one-stop shopping,” and he shared the concept with a panel that met at the Harvard Law School in Cambridge, Massachusetts.

De Jonge is involved in an effort by the school’s Petrie–Flom Center to address care for people who are seriously ill. The center is working with the nonprofit Coalition to Transform Advanced Care (C-TAC) to apply an “interdisciplinary analysis to important health-law and policy issues raised by the adoption of new person-centered approaches to care for this growing population,” according to the center's website.

The panel, which convened on March 17, included representatives from organizations interested in services for and the needs of frail, elderly, and seriously ill patients. Panel members were asked to consider a draft proposal for “a care model implementation framework” for patients with serious illnesses.

Members of the panel included providers, payers (costs were on the table), and programs involved in the care of the seriously ill. Home health, palliative care, hospice care, and primary care were all represented.

Payment models were also on the panel’s agenda for future discussion. At MedStar, De Jonge said the system assumes all of the risk for some of its patients. That allows the health system to tap into new payment models, which include coverage for services such as home-based primary care.

The MedStar program was part of a Centers for Medicare and Medicaid Services demonstration project called Independence at Home. It identified 15 services that aging patients may need, and MedStar put together a team to make them available.

The team was able to reduce readmissions and to cut costs for high-risk Medicare patients with programs such as house calls and home-based primary care.

The C-TAC effort will explore costs and identify payment reforms to allow reimbursement for such teams.

In a study published in the Journal of the American Geriatrics Society, De Jonge reported that the cost per Medicare patient enrolled in the program dropped 13% to $44,455 from $50,977.

The per-patient cost of hospital care declined 19.4% to $17,805 from $22,096, and the cost declined 20.1% for skilled nursing-facility care to $4,821 from $6,098, while costs for home health care and hospice care grew.

There were no differences in mortality or in the average time to death.

De Jonge said he expects the panel to describe the key elements of a care team for the seriously ill and to identify payment reforms to allow reimbursement for that team.

Source: HealthLeaders Media; March 16, 2017.

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