HOWTO make health-care cheaper by spending more on patients who need it

Atul Gawande's New Yorker feature "The Hot Spotters" is a fascinating look at a small group of doctors and medical practitioners who are working on reducing systemic health care costs by doing data-analysis to locate the tiny numbers of chronically ill patients who consume vastly disproportionate resources because they aren't getting the care they need and so have to visit the emergency room very often (some go to the ER more than once a day!) and often end up with long ICU stays.

The approach is marvellous because it is both data-driven (data-mining is used to identify which patients aren't getting the care they need) and extremely compassionate ("super-utilizers" are voluntarily enrolled in programs where they get 24/7 guaranteed access to doctors, nurses and social workers). The programs are successful, and even though they cost a lot to administer, they still generate system-wide savings -- one patient helped with this sort of care had previously cost $3.5 million a year because of heavy ER and ICU use. In other words, providing excellent, personalized care to the small number of patients who don't fit the system's model saves far more money than making the system more stringent, with more paperwork, higher co-pays and other punitive measures. It's a win-win.

Except that it's not really catching on. Some of the doctors pioneering this approach are frustrated because they can save Medicare or an insurer millions, but they can't get funded by Medicare or the insurers -- instead, they have to fundraise from private foundations. Read the rest

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