Looking Beyond Utilization Management
For this blog post I chose to write about an article from
the HFMA Magazine. The article was titled “Looking Beyond Utilization
Management: Controlling Inpatient Cost in a Value-Based Environment.” Costs are
a hot topic in the health care discussion, as the costs rise less people are
able to afford insurance and receive care. The United States spends $3.2
trillion on health care, about 18% of GDP which is expected to rise to close to
20% by 2025. Many hospitals work to reduce the number of admissions and the
inpatient length of stay as well as limiting the number of expensive outpatient
interventions. Using this approach, it seems the healthcare system is working
towards lowering the costs but when it is compared to the inpatient costs it
shows the system has a unit-cost problem.
In order for the costs to drop hospital officials need to
consult with physicians and work to develop a new strategy. Instead of focusing
on utilization the focus needs to change to addressing the unit-costs. One
example in the article was the use of midwives in the United Kingdom. In the
United States 99% of births are in the hospital and 8% were attended by a
midwife while in the UK 68% were attended by a midwife. The study they
conducted found healthy woman with a low-risk pregnancy can give birth more
safely under the care of a midwife than a physician’s care. The use of midwives
helps to drive the unit costs down. This is one example of a way the United
States can start to implement new strategies to lower the cost.
Part of your research for your case? Using lower level providers definitely needs to be part of our health system's solution.
ReplyDeleteMany healthcare organizations are creating patient centered medical homes, and these models include lower level providers, NPs, and PAs, to help reduce the unit cost, but increase the amount of patients being seen, the lower level acuity patients see the lower level providers, allowing the physicians to see the more complex patients.
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