Recently an article in Marketplace http://www.marketplace.org * noted: “We can actually take the sickest and most complicated patients, go to their bedside, go to their home, go with them to their appointments and help them for about 90 days and dramatically improve outcomes and reduce cost…”
“That’s the theory anyway. Like many ideas when it comes to treating the sickest patients, there’s little data to back up that it works.”
“Helping lower costs and improve care for the super-utilizers is one of the most pressing policy questions in healthcare today. And given its importance, there is a striking lack of data in the field.”
People like to call randomized controlled trials (RCTs) the gold standard of scientific testing because two groups are randomly assigned – one gets the treatment, while the other doesn’t – and researchers closely monitor differences. But a 2012 British Medical Journal article found over the last 25 years, a total of six RCTs have focused on care delivery for super-utilizers.”
“Every major health insurance company – Medicare and Medicaid, too – has spent billions on programs for super-utilizers. The absence of rigorous evidence raises the question: Is all this effort built on health policy quicksand?”
“Healthcare has benefitted from the fact that you don’t understand it. It’s a bit of an art, and it hasn’t been a science….You made money in healthcare by putting a banner outside your building saying you are a top something without having to justify whether you really are top at whatever you do.”
“….it’s too easy – and frankly, wrong – to say the main reason doctors avoid these rigorous studies is because they’re afraid to lose money and status. He said doctors aren’t immune from the very human trap of being sure their own ideas are right. …. psychologists call it confirmation bias. …“Everything you see is filtered through your hopes, your expectations and your pre-existing beliefs…” “Providers have a lot more incentive now than they use to,” she said. “They have much more skin in the game.”
* to read the full Marketplace article “Using data to treat the sickest and most expensive patients” by Jessica Kourkounis , highlight and click on open hyperlinkhttp://www.marketplace.org/topics/health-care/diagnosis-camden/using-data-treat-sickest-and-most-expensive-patients?utm_campaign=KHN%3A+Daily+Health+Policy+Report&utm_source=hs_email&utm_medium=email&utm_content=12602330&_hsenc=p2ANqtz-80fSnkOFukvy4pilVWU-S1rioNrPvot0RSmbytq_m0-gljXSPA423gUuTJsbTSUQ8apjvM6ahCTKz_F12HMoTmuJoZbcrT1OhTBuwFuanexZJ2M6U&_hsmi=12602330
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Jonathan M. Metsch, Dr.P.H., is Clinical Professor, Preventive Medicine, Icahn School of Medicine at Mount Sinai; and Adjunct Professor, Baruch College ( C.U.N.Y.), Rutgers School of Public Health, and Rutgers School of Public Affairs and Administration.
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