Abstract
Objective: Patient-centered healthcare and its components of human interaction in an era of accountable healthcare and healthcare reform enables proactive preventive healthcare, saves millions in public funds, and decreases unnecessary emergency room (ER) visits; it comports with 2010 Accountable Care Act (ACA) mandates to establish patient-centered medical homes (PCMH) and accountable care organizations (ACO) which limit diagnostic testing and some treatments and hold physicians accountable for care outcomes.
Method: The Camden Healthcare Coalition (CHCC) analyzed patient usage of ER resources and applied this to set up cost-effective PCMHs and ACOs. Electronic medical record (EMR) data were shared with Camden hospitals and a profile of “super-utilizers” was developed: 20% of patients generated 90% of costs; the top 1% of super-utilizers made between 24 and 324 emergency room visits/five years; one patient was hospitalized 113 times in one year; 30 patients accounted for one-third of Camden’s medical costs; and nearly $375 million in uncompensated care was provided.
Results: With a modest grant and state legislation, CHCC developed a PCMH without walls for super-utilizers: Teaching and treatment teams led by nurse practitioners visited patients in shelters and on streets. There were 40% fewer monthly ER visits, 56% less charges; reimbursements increased 50% because of enrollment of super-utilizers in insurance programs.
Conclusion: The CHCC model for proactive care for super-utilizers provided better care—not withdrawal of care. Other cities could effectively share data and utilize the teams approach to healthcare management for super-utilizers and other patient groups. Our model is now being considered nationally.
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