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.

HFMA Magazine 

Comments

  1. Mark BonicaNovember 9, 2017 at 8:05 AM

    Part of your research for your case? Using lower level providers definitely needs to be part of our health system's solution.

    ReplyDelete
  2. MelissaDecember 6, 2017 at 7:55 PM

    Many 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.

    ReplyDelete

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