Lala Tanmoy Das1,2,3, Rainu Kaushal4, Kelsey Garrison5, Vanessa Carrillo6, Zachary Grinspan7,8, Ryan Theis9, Elizabeth Shenkman10, Erika Abramson8,11. 1. MD-PhD Student, Weill Cornell/Rockefeller/Sloan Kettering Tri-Institutional MD-PhD Program, USA. 2. MD-PhD Student, Weill Cornell Graduate School of Medical Sciences, USA. 3. MD-PhD Student, Weill Cornell Medicine, USA. 4. Chair of Healthcare Policy & Research, Department of Healthcare Policy & Research, Weill Cornell Medicine, USA. 5. M.S. Graduate Student, Weill Cornell Graduate School of Medical Sciences, USA. 6. Research Coordinator, Weill Cornell Graduate School of Medical Sciences, USA. 7. Associate Professor of Health Care Policy & Research, Department of Healthcare Policy & Research, Weill Cornell Medicine, USA. 8. Associate Professor of Pediatrics, Department of Pediatrics, Weill Cornell Medicine, USA. 9. Assistant Professor, Health Outcomes & Biomedical Informatics, Department of Health Outcomes and Policy, College of Medicine, Institute for Child Health Policy, University of Florida, USA. 10. Professor and Department Chair, Health Outcomes & Biomedical Informatics, Department of Health Outcomes and Policy, College of Medicine, University of Florida, USA. 11. Associate Professor of Healthcare Policy & Research, Department of Healthcare Policy & Research, Weill Cornell Medicine, USA.
Abstract
OBJECTIVES: A small percentage of patients account for the bulk of population health care utilization and costs in many countries including the United States (US). In the US, 5% of the population has high health care utilization accounting for nearly 50% of health care costs. A subset of this utilization is deemed preventable, and thus potentially cost saving to patients as well as to the health care system. This study sought to identify drivers of preventable utilization from the perspectives of three stakeholder groups in the US: health system leaders; high-need, high-cost (HNHC) patients or their primary caregivers; and physicians. METHODS: We performed a qualitative study using interviews of health system leaders and focus groups of HNHC patients, caregivers and physicians. We used a mixed inductive deductive approach to analyse transcripts and identify themes. RESULTS: We identified three key drivers of preventable high health care utilization: (1) unmet behavioural health needs, (2) socio-economic determinants of health and (3) challenges associated with accessing health care delivery systems. CONCLUSIONS: To be potentially more effective, interventions to reduce preventable high health care utilization should incorporate the perspectives of patients, health system leaders and physicians. Particularly important to stakeholders is increased access to mental-health resources, support for patients with low socio-economic resources and systemic changes that reduce wait times for primary care visits and allow providers more time during patient visits.
OBJECTIVES: A small percentage of patients account for the bulk of population health care utilization and costs in many countries including the United States (US). In the US, 5% of the population has high health care utilization accounting for nearly 50% of health care costs. A subset of this utilization is deemed preventable, and thus potentially cost saving to patients as well as to the health care system. This study sought to identify drivers of preventable utilization from the perspectives of three stakeholder groups in the US: health system leaders; high-need, high-cost (HNHC) patients or their primary caregivers; and physicians. METHODS: We performed a qualitative study using interviews of health system leaders and focus groups of HNHC patients, caregivers and physicians. We used a mixed inductive deductive approach to analyse transcripts and identify themes. RESULTS: We identified three key drivers of preventable high health care utilization: (1) unmet behavioural health needs, (2) socio-economic determinants of health and (3) challenges associated with accessing health care delivery systems. CONCLUSIONS: To be potentially more effective, interventions to reduce preventable high health care utilization should incorporate the perspectives of patients, health system leaders and physicians. Particularly important to stakeholders is increased access to mental-health resources, support for patients with low socio-economic resources and systemic changes that reduce wait times for primary care visits and allow providers more time during patient visits.
Entities:
Keywords:
United States; high-need/high-cost patients; prevention
Authors: Róbert Pónusz; Dóra Endrei; Dalma Kovács; Evelin Pónusz; Bence Kis Kelemen; Diána Elmer; Noémi Németh; András Vereczkei; Imre Boncz Journal: BMC Health Serv Res Date: 2022-06-20 Impact factor: 2.908
Authors: Cynthia F Corbett; Kenn B Daratha; Sterling McPherson; Crystal L Smith; Michael S Wiser; Brenda K Vogrig; Sean M Murphy; Roy Cantu; Dennis G Dyck Journal: Int J Environ Res Public Health Date: 2021-05-26 Impact factor: 3.390