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Managing the Most Expensive Patients

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Discussions about reining in health care costs invariably turn to the sickest 5% of the population, who account for 50% of all health care spending. Many of these patients have multiple chronic conditions, and the hope is that through disease-management programs that use registered nurses and social workers to monitor and help them, we can care for them better and achieve big savings. But these programs are expensive. Typically each focuses on just one disease, which means that many patients deal with multiple teams. The programs also operate outside primary-care practices, so they often duplicate doctors’ work as well. And in the experience of the authors, the former CEO and associate executive director of Kaiser Permanente (KP), they do not reduce net costs. KP has come up with a better approach: providing coaching and support to patients through IT and inexpensive assistants who are integrated into primary-care practices—avoiding duplication. KP applies it judiciously, focusing only

Health and behavioral science Managing the Most Expensive Patients A new primary-care model can lower costs and improve outcomes. by Robert Pearl and Philip Madvig From the Magazine (January–February 2020) Paul Garland Summary . Discussions about reining in health care costs invariably turn to the sickest 5% of the population, who account for 50% of all health care spending. Many of these patients have multiple chronic ... more Leer en español Ler em português Post Post Share Save Get PDF Buy Copies Print When corporate executives, health care leaders, and policy makers discuss the challenge o

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