Nav: Home

Health care intervention: Treating high-need, high-cost patients

October 17, 2019

In crisis and with nowhere else to turn, thousands of patients with complex needs -- serious mental and physical health problems and substance use disorders -- every year flock to emergency rooms in Harris County, Texas and across the country. Referred to as "high-need, high-cost," these patients have limited ability to take care of themselves, making it challenging for doctors to find effective treatments.

Their health problems are mostly left unresolved, and they consistently return to the ERs costing the health care system billions every year. The ERs are not designed to address chronic medical or acute social problems such as homelessness, hunger, and job loss.

New research suggests a nontraditional approach to these patients can significantly improve their daily functioning and health outcomes.

Complicating matters, patients with a number of different diagnoses typically visit multiple medical and social service agencies -- hospital systems, health clinics, food pantries, shelters -- with no collective record available to each organization. This can lead to both gaps and overlapping services, resulting in higher costs and insufficient care.

"The diagnostic-based approach -- telling patients what's wrong and here's how to fix it before sending them on their way -- coupled with a lack of information about where they've been, has worked spectacularly badly for underserved populations who already have reason not to trust us," said Dr. David Buck, associate dean for community health at the University of Houston College of Medicine. "We need to find a better way to not only lower health care costs, but more importantly, improve their quality of life."

In a study published in the journal Population Health Management, Buck and his research team report a novel intervention that integrates a psychological, values-based approach with coordinated care management significantly helped improve daily functioning --including money management, personal hygiene, social connectivity and relationships -- for this vulnerable group of patients.

This "values-based" approach to care was applied to 18 high-need, high-cost patients at the Patient Care Intervention Center in Houston, a nonprofit organization founded by Buck. Over the course of six months, care coordinators worked with the patients to identify their values and associated goals as a way to start meaningful discussions and ultimately engage them in appropriate care.

Buck calls it a way of "centering" providers on who or what is most important to the patient through a cognitive behavioral therapy informed approach.

"Instead of focusing on their problems, we focus on their values and goals. Instead of the push and pull of doctors telling patients not to do something for the sake of their health, we look at who and what is most important to the client," said Buck. "It's trust building and a way to reach the root of the problem."

The nonprofit also integrates millions of service utilization records from medical and social service agencies through its comprehensive health record system, called the Unified Care Continuum Platform. By linking data from patient visits, the researchers wrote, "communication gaps between agencies (that work independently) are bridged to provide a complete view of utilization and needs, as well as identify common clients and service gaps in the community. This helps to overcome systemic barriers to health that might exist and reduce duplication of services."

Buck recalls a patient with HIV and bipolar disorder who showed up at emergency rooms every few days. The patient racked up more than $1 million in bills. "No one was successful in engaging him. He hated the ER's, but he was in crisis," said Buck, who discovered that the patient's dog was his main motivation. The patient left his dog tied up and alone for days whenever he went to the hospital.

"Instead of just demanding he get on his meds, we discussed what was not working for him. Instead of getting in the medical zone, we would go back to the dog. He didn't like leaving his best friend behind. We would ask what was getting in the way of his value to be good to his dog. He identified his need to get primary care for his chronic illnesses rather than acute crisis care. This approach gives people the power to decide how they need to behave instead of being told," Buck said.

The patient now regularly visits a primary care clinic, avoiding the emergency room. Buck said if the intervention could positively impact even the most challenging patients, it has implications for improving health care for everyone.
-end-
Other researchers involved in the study include Stephanie Barker and Nick Maguire from the University of South Hampton and Sophiya Das, Victoria Bryant and Kallol Mahata from the Patient Care Intervention Center. The study was funded by the Episcopal Health Foundation, Cullen Trust for Health Care and the Rockwell Fund.

University of Houston

Related Primary Care Articles:

Women almost twice as likely to choose primary care as men
Analysis of osteopathic medical school survey data reveals women are 1.75 times more likely to choose primary care than men, according to a study in The Journal of the American Osteopathic Association.
Spending on primary care vs. other US health care expenditures
National health care survey data were used to assess the amount of money spent on primary care relative to other areas of health care spending in the US from 2002 to 2016.
Lung cancer screening in primary care
The benefits of routine lung cancer screenings have been hotly debated in the medical community.
After cancer: The role of primary care in cancer survivorship care
Primary care physicians are treating an increasing number of cancer survivors, yet they have no clear guidance on how best to care for such patients.
A hidden history of artificial intelligence in primary care
Artificial intelligence methods are being utilized in radiology, cardiology and other medical specialty fields to quickly and accurately process large quantities of health data to improve the diagnostic and treatment power of health care teams.
High reliance on urgent care centers may disrupt primary care in children
A study of over 4 million children and adolescents in the US enrolled in Medicaid found that those who rely on urgent care centers for more than a third of their outpatient health care needs had fewer visits to primary care providers.
Contacts with primary care physicians did not increase after the Affordable Care Act
At the same time the Affordable Care Act increased the number of insured Americans, analysis of health care industry data shows a continued decline in contact with primary care physician services.
Case management in primary care associated with positive outcomes
In a systematic review, researchers identified three characteristics of case management programs that consistently yielded positive results: case selection for frequent users with complex problems, high-intensity case management interventions and a multidisciplinary care plan.
A new approach to primary care: Advanced team care with in-room support
In this special report, the authors argue that the current primary care team paradigm is underpowered, in that most of the administrative responsibility still falls mainly on the physician.
How primary care physicians can make Astana work
The Astana Declaration, adopted by the World Health Organization in October 2018, acknowledges the importance of primary health care to achieve better health outcomes globally.
More Primary Care News and Primary Care Current Events

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Listen Again: Meditations on Loneliness
Original broadcast date: April 24, 2020. We're a social species now living in isolation. But loneliness was a problem well before this era of social distancing. This hour, TED speakers explore how we can live and make peace with loneliness. Guests on the show include author and illustrator Jonny Sun, psychologist Susan Pinker, architect Grace Kim, and writer Suleika Jaouad.
Now Playing: Science for the People

#565 The Great Wide Indoors
We're all spending a bit more time indoors this summer than we probably figured. But did you ever stop to think about why the places we live and work as designed the way they are? And how they could be designed better? We're talking with Emily Anthes about her new book "The Great Indoors: The Surprising Science of how Buildings Shape our Behavior, Health and Happiness".
Now Playing: Radiolab

The Third. A TED Talk.
Jad gives a TED talk about his life as a journalist and how Radiolab has evolved over the years. Here's how TED described it:How do you end a story? Host of Radiolab Jad Abumrad tells how his search for an answer led him home to the mountains of Tennessee, where he met an unexpected teacher: Dolly Parton.Jad Nicholas Abumrad is a Lebanese-American radio host, composer and producer. He is the founder of the syndicated public radio program Radiolab, which is broadcast on over 600 radio stations nationwide and is downloaded more than 120 million times a year as a podcast. He also created More Perfect, a podcast that tells the stories behind the Supreme Court's most famous decisions. And most recently, Dolly Parton's America, a nine-episode podcast exploring the life and times of the iconic country music star. Abumrad has received three Peabody Awards and was named a MacArthur Fellow in 2011.