NEJM: Follow the Money — Controlling Expenditures by Improving Care for Patients Needing Costly Services (Dr. T. Bodenheimer, R. Berry-Millett)

NEJM stands for the New England Journal of Medicine. According to wikipedia "it is the oldest continuously published medical journal in the world, and is the most widely read, cited, and influential general medical periodical in the world."

I like this article because it addresses two issues that I'm currently very interested in: 1) Healthcare reform 2) Geriatrics. According to this article, 10% of patients account for 70% of total health care expenditures. Many of these 'high-risk' patients are elderly and/or patients with multiple chronic conditions. The article then goes on to propose a new way of treating these people with complex health care needs that would reduce costly hospitalizations and emergency visits through something called "Care Management". Care Management would involve a team consisting of physicians, nurses, and social workers that would develop an individualized care plan for each patient.

"The specific activities of such care managers include assessing the risks and needs of each patient; working with the patient, his or her family, and the primary care physician to prepare a care plan; teaching patients and their families about their diseases and medications; coaching patients and families on how to respond to worsening symptoms in order to avoid emergency department visits and hospital admissions; tracking patients’ status over time; and revising care plans as needed."

The benefits of Care Management still need to be further tested with more study cases; however, even if it does prove to be an effective way to treat patients with complex conditions there's currently no way to 'reward' healthcare providers to do this sort of preventative care for their patients. The way the system works now hospitals actually profit from these patient readmissions and emergency visits. This article further shapes my belief that in order to effectively contain the cost of healthcare spending, the health industry needs to reform the way doctors/hospitals are compensated. There needs to be a shift to rewarding physicians who keep their patients out of hospitals and off of medications. Also, I believe that more of medicine should be about prevention and there is a need to more fully merge the fields of public health and medicine. It is the social responsibility of doctors to save lives, so why start when it's already too late?

Follow the Money — Controlling Expenditures by Improving Care for Patients Needing Costly Services