Health Policy Game Changers: Coordinated Care, Biomedical & Analytical Innovations

On Thursday, April 5th, Massachusetts State Senator Karen Spilka and Representative Joseph Wagner, co-chairs of the Biotech Caucus, hosted a Biotech Caucus Meeting featuring Mary Kay Owens, Executive Director of the Institute for Healthcare Innovation Strategies, who spoke to Legislators and their staff on biomedical and analytical innovations and the impact of these advances on behavioral health and mental health policy initiatives. You can download her presentation here: MassBio Caucus Forum April 5_2012 MK Owens.

Mary Kay Owen recently authored a new study published in the workshop series compilation, The Healthcare Imperative: Lowering Costs and Improving Outcomes by the Institute of Medicine which asserts, based on analysis of more than 9 million insured lives in five states, that uncoordinated care costs America an average of $240 billion a year. This money is wasted on unnecessary and inappropriate delivery of services due to uncoordinated care that compromises quality of care for the entire system. The study offers new insights and methods to decrease this expenditure relevant for those involved in public and commercial health care plan administration, health care policy and reform, fiscal planning and patient care.

Rather than focusing on high cost patients who who often have appropriate care, the study suggests focusing on the subset of the population with the most savings and quality improvement opportunities. That population includes those who are receiving extremely fragmented care and are accessing the system in a very inefficient and uncoordinated manner such as those people seeing multiple doctors with no prior knowledge of medical history.  The study also asserts that the average annual cost for an extremely uncoordinated care patient was more than five times higher than other patients and patients with the most uncoordinated care represented on average about 10 percent of patients yet accounted for approximately 45 percent of drug costs, 30 percent of medical costs, and 35 percent of total health care costs for that population annually.

(Read more about the study here: Press Release: Cost of Uncoordinated Care.)

An estimate average annual savings of over $240 billion (average of 9 percent) in total direct health care spending for drugs and medical services that could be achieved if care were better coordinated translates into a cumulative potential savings of over $2 trillion by 2018.

Uncoordinated care must be addressed as part of the state and national health care reform efforts.

Here are some powerful examples from Mary Kay’s presentation:

Read Owens’ suggested initiatives to move toward coordinated care online at What is the Path to Success? By Southeastern Consultants, Inc.

Owens suggests that we have been asking the wrong questions and often focusing intensive management efforts on the wrong subset of patients. The question should be “Who are the patients with the most opportunities for impact on cost and quality of care?” and not just “Who are our high cost, complex, chronic disease patients?”

It is clear that moving from uncoordinated to coordinated healthcare will continue to be an important part of the health policy conversation moving forward.

In her role at the Institute for Healthcare Innovation Strategies, Mary Kay Owens provides consultation and advanced analytical services to federal and state agencies including Medicaid, Medicare, and employers as well as to health plans, healthcare collaboratives, providers, accountable care organizations, and patient advocates. For more information contact Mary Kay Owens at mowens@sec-rx.com.