American’s reliance on the hospital emergency department (ED) continues to soar, even though many of these visits could have been prevented with timely access to primary care. When someone has a regular medical home, they have a better chance at good health, which in turns generates cost savings to hospitals and payers.
With mounting concerns over rising health care costs and rising rates of emergency department visits, payors across every state have been looking at strategies to control ED spending over the last several years—that is where the Foundation for Complex Healthcare stepped in.
How our Program Worked
When high-utilizing patients entered the emergency department – staff were trained to immediately engage in assessment, discuss the intervention process, and enroll members in our program called Enhanced Care.
The Foundation of Complex Healthcare Solutions has worked on several emergency department avoidance programs with IU Health, Regenstrief Institute, ISDH, and Park Center since 2010. Hundreds of participants have been identified as high utilizers and have been enrolled in our program from multiple hospital settings.
Results of the Enhanced Care program included: breaks in previous ED utilization trends, lower patient claim costs and higher patient adherence and quality of life.
Hemophilia Disease Management
Hemophilia is a hereditary blood disorder that is life-long and has very high costs to treat. A patient with a moderate condition faces average annual expenses of $200,000 to $300,000. For a patient with a severe case, the cost can be $500,000 or more. The main driver of these expenses is the cost of the blood factor products that hemophilia patients need to prevent terminal bleeding. The goal of the Hemophilia program was to improve health care outcomes and reduce costs for people with Hemophilia and blood related disorders.
The individualized DM plans utilized focused clinical techniques and relied on intensive commitments from hemophilia care providers, patients, and patient families. Patients and their families worked closely with experts in hemophilia care to learn how best to manage the disorder. Overall costs were lowered through improved patient knowledge and shared commitment of all partners including state and federal agencies and insurance programs. The Program worked with a Federally Licensed Treatment Center to work directly with patients. The results were better patient care at a significantly reduced cost.
During the four years of active program management, the Hemophilia program reduced overall expenses and improved health care outcomes for 55 hemophilia patients in Indiana, saving more than $16 million over four years. This was accomplished by reducing the cost of blood factor products and working with each individual on a Disease Management (DM) plan tailored to that person’s needs.