The math is basic. Unnecessary emergency room visits and hospitalization are some of the most expensive parts of our health care system. An estimated 60 to 70 percent of health care costs are for chronic conditions that without proper treatment result in more expensive crisis or hospital care. Hospital costs are also about 40 percent of Oregon Health Plan costs, taking up the largest percentage of the budget. Those are dollars that could be paying for prevention, for primary care services, or for education.
Not only are many of these costs unnecessary, but much of the suffering that comes from an advanced chronic disease could be avoided if our health care system was organized around people, not systems.
It's one of the fundamental facts about health care: better care means lower costs. In Oregon over the past few weeks there have been several newspaper articles about how patient-centered medical homes work to keep costs down. Atul Gawande, a surgeon and writer who has become one of the most eloquent witnesses to the illogic of our health care system, recently wrote about just that in a recent article.
Dr. Gawande studied innovative programs with low-income patients in New Jersey and Massachusetts. They were designed to lower costs and improve care for the "super-utilizers" of care. Those are people who are more frequently in emergency care or hospital care.
One thing the programs had in common is the understanding that personal and frequent contact with these patients is key to managing their conditions and keeping them from unnecessary hospitalization. Also important was integrating medical care with models of social work. Sometimes a reminder to fill a prescription medication was all that was needed. Other times it was assistance with filling out a voucher for stable housing. These are the kinds of activities that keep people healthier and reduce costs.
The results were impressive. I urge you to read the article yourself. You can find it in The New Yorker's January 24, 2011, issue or online. In Camden, New Jersey, for example, a team of people focused on just 36 super-utlizers. Before the program, low-income clients averaged 62 hospital and E.R. visits per month before joining the program and 37 visits after joining -- a 40 percent reduction. According to the article their hospital bills averaged $1.2 million per month before and just over half a million after -- a 56 percent reduction. Patients were healthier and better able to manage their conditions.
This kind of intensive care requires extra staffing, more prescriptions and other preventive care. But these kinds of savings make those kinds of investments well worth it.
Programs like this are happening in pockets of innovation across the country. And that's another important lesson -- health care reform is local.
With our current budget situation, Oregon can no longer afford to waste precious public resources in a health care system that doesn't take those lessons to heart.