Focus Programs on Heaviest Users of Healthcare

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Karen Utterback By Karen Utterback 
Vice President, Strategy, McKesson
Focus Programs on Heaviest Users of Healthcare

Research from the U.S. General Accountability Office shows that just 5% of Medicaid enrollees account for nearly one-half of expenditures for Medicaid-only patients.

Identifying these patients and taking a proactive approach to help them manage their conditions and adhere to medications and treatment protocols would seem like a logical next step to improve quality of life for these patients while cutting costs. It also sounds like an area where home care organizations could take a leading role. What disease management or medication adherence protocols have your organization developed? How are you working with health systems and providers to extend care beyond the four walls of a hospital or physician office into the home?

The GAO report covers fiscal years 2009-2011, and it’s surprising how close each year’s expenditures mirror the trajectory of the other years. For each year studied:

  • The most expensive 1% of Medicaid-only enrollees in the nation accounted for about one-quarter of the expenditures for Medicaid-only enrollees
  • The most expensive 5% accounted for almost half of the expenditures
  • The most expensive 25% accounted for more than three-quarters of the expenditures
  • In contrast, the least expensive 50% accounted for less than 8 percent of the expenditures
  • About 12% of enrollees had no expenditures

The GAO report findings broadly mirror another report prepared by the Agency for Healthcare Research and Quality that I told you about in 2013. Looking across the patient spectrum in 2010, the report showed by 5% of patients accounted for 50% of all expenses. There were small outliers on either end, with 1% of patients accounting for 21% of all spending, while the bottom 50% of patients consumed just 2.8% of each healthcare dollar.

From the GAO report, it’s becoming clear that a small percentage of patients use a disproportionate amount of healthcare. While access to care and the ability to pay for that care likely exacerbate many healthcare issues, we also know that chronic conditions are a huge issue – especially among older Americans.

Helping the heaviest users of healthcare, either directly or in partnership with other providers, is not only the right thing to do, it also could improve your bottom line and reputation in your community.

Explore more of the latest healthcare industry trends and opportunities in the McKesson Homecare Talk Resources Center.

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