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  • Health Care’s Key Issues: Improve Chronic Conditions, Mental Health, Optimizing End-of-Life Care

    HFMA News

    View the slides from Joe Fifer's 2017 ANI presentation.

    June 27—Committing to the Institute for Healthcare Improvement’s (IHI) Triple Aim of improving population health and patient experience, while reducing costs is also an organization’s best chance for long-term success, said HFMA’s President and CEO Joe Fifer at HFMA’S ANI 2017 in Orlando.

    Joe Fifer discusses how improving care for chronic conditions, mental health, and end of life while reducing costs are keys to success in health care.The reason, Fifer said, is that the traditional payment model of fee-for-service is not sustainable.

    “In the long term, payment for volume will be replaced with payment for value. With healthcare expenditures as a percentage of GDP edging up again, and projected to reach 19.9 percent of GDP by 2025, it seems like we can’t live in denial about this much longer. At this rate, healthcare spending will soon squeeze out other priorities for our society, if they haven’t already,” Fifer said.

    There are three core issues that health care should address in the short term to help bend the cost curve and achieve the Triple Aim, including managing chronic conditions, integrating mental health and substance abuse into mainstream health care, and optimizing end-of-life care, Fifer said.

    “You can’t improve population health and reduce the per capita cost of care without managing chronic conditions,” Fifer said.

    Consider these statistics:

    • 86 cents of every dollar spent on health care goes to treating people with a chronic condition.
    • Healthcare costs are highly concentrated with 5 percent of the population with multiple chronic conditions accounting for more than half of all healthcare spending. 
    • Compared to a person without any chronic conditions, spending is almost 2.5 times more for those with one chronic condition, and six times more for people with three chronic conditions.
    • Increased utilization is linked to a number of chronic conditions across the board, including emergency department visits, inpatient stays, and outpatient visits.

    Substance abuse and mental health disorders also represent an important improvement area for health care. It starts with recognizing and addressing substance use disorders in mainstream healthcare settings.

    “Having a substance use disorder can double the odds that a person will develop another chronic and costly medical condition, like arthritis, chronic pain, heart disease, stroke, hypertension, diabetes, or asthma,” Fifer said.

    Additionally, opioid, heroin, and other substance use addictions are significant societal problems.

    “One of the key recommendations in the Surgeon General’s report on addiction is very similar to the recommendation that applies to other chronic conditions: catch it early and you can avoid costly complications and treatment later. Yet, how many people even have addiction treatment on their radar screens? How many value-based payment experiments incorporate substance abuse and mental health components? The answer is very few,” Fifer said.

    End-of-life care also represents an important issue for the industry.

    “The care that people receive near the end of their lives often does not reflect their values, goals, and the preferences that they express when they are fully informed. Although most people say they would prefer to die at home, two-thirds of Medicare beneficiaries die elsewhere, sometimes in an intensive care unit where they endure unwanted and unnecessary aggressive treatment,” Fifer said.

    But there are models that have been proven to result in honoring patients’ wishes for end-of-life care, notably Gundersen Health System’s Respecting Choices program, which has become a national model, Fifer said.

    When you broach the subject of end-of-life care, cost is an important issue that needs to be addressed openly to help patients and families make thoughtful and compassionate decisions about end-of-life care.

    “Roughly 25 percent of traditional Medicare spending is for care in the last year of life—a proportion that has remained steady for decades. While end-of-life decisions are not easy and must not be driven by financial considerations, doing the right thing—by identifying peoples’ choices and honoring them—prevents the use of expensive resources that patients don’t value or benefit from. In other words, having honest end-of-life conversations based on a structured process, choosing the right environment for those final days or weeks, is the right thing for patients and their families. And it’s cost effective. It’s that simple. It’s the essence of improving value in health care. We should not be afraid to talk about this. The reality is that following people’s end-of-life wishes is not only best for them, it’s best for our healthcare system and our society.”

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