Addressing High Utilization in Medical Care

a teenage girl having her eyes checked by a doctorThe health care system in the United States is the most costly in the world. Health leaders are pushing for the Triple Aim initiative, the goal of which is to simultaneously improve the health of the population, improve the experience of care, and lower the per capita cost of care.

With this comes a considerable chance for advancement in hospital utilization management, especially since private, state and federal sector entities allocated resources to new, high-utilizer enterprises like Case Management Innovations. These include modules of accountable care organizations, requirements of Section 1115 Medicaid demonstration waivers and health homes. For many cases, they can usually prevent or largely mitigate the settings that trigger undue utilization.

Complicated interventions

Populations that are high-utilizing require receptive and coordinated care. They require access to an array of social and health services. Moreover, they need an atmosphere that supports and encourages health maintenance. Taking care of populations that have complicated social and health requirements need enough complicated interventions.

A thorough approach

Offering integrated care may assist in handling the condition of an individual. However, the advances in population health will be minimal if they do not address fundamental problems, like access to affordable, stable and safe housing.

Individual referrals to community-based groups and social services are crucial, but it is also essential to build tactical relationships to promote an integrated reaction to housing security. Moreover, they must also support policy changes and advocacy that guarantee the availability of resources to every resident.

Return on investment

It is important for all health care leaders to enhance community surroundings to match their coordinated and developed service delivery. As they think about the choices to boost quality and lower costs, they have the chance to incorporate thorough models that link effective care management with superior prevention. Investing in these can lead to short- and long-term outcomes to transform the health of the population, as well as healthcare.