Southeastern Consultants, Inc. (SEC) performed comprehensive claims analyses on over 9 million Medicaid only enrolled patients and Medicaid/Medicare dually enrolled patients for five large states, which included utilization and expenditure analyses of drugs and medical services, a disease profile of the population, and the identification of access patterns indicative of uncoordinated care in a subset of the population. SEC examined drug and medical utilization and costs attributed to these extremely uncoordinated care patients in an effort to supply policy makers addressing health care reform at the state and federal levels with compelling new data as to the importance of improving the coordination of care. In addition, SEC conducted statistical-based, predictive modeling to estimate future expected costs and created matched comparison groups to further evaluate estimated program savings following a multiple intervention approach to better coordinated care using a patient-centered, primary care medical home model with enhanced health information technology applications and provider incentive payment models.
The summary of these analyses can be found by clicking here.
The primary conclusions of this study are that:
A) The Rise in Health Care Costs is Unsustainable
"Bending the growth of spending in health care is critical to Federal and state programs, our economy and our future. It appears equally clear that there is no easy silver bullet that can accomplish this. However, reducing uncoordinated care, overutilization and the medical errors that flow from the lack of coordination would be among several important steps."
B) Focusing Care Coordination Resources by Indentification and Action Can Save Hundres of Billions of Dollars a Year
"A new study adds to the body of evidence showing it is possible to identify indicia and patterns of uncoordinated care through readily available claims data bases. [In this SEC study], uncoordinated care patients represented less than 10% of patients, but they accounted for an average of 46% of drug costs, 32% of medical costs, and 36% of total costs for the population."
"According to the study, if health reform efforts aimed at these uncoordinated care patients are developed now and phased in over three years (realizing savings at 25, 50, and then 75% levels_, the average savings in the period 2010-2018 are estimated at $240.1 billion per year or an average of 8.8% of the total annual expenditures for direct care services."
C)The Ability to Identify Patterns of Uncoordinated Care Allows for Specific Actions in Policy and Care Delivery
"This study and other evidence support a process which allows specific and focused corrective actions in the care delivery system."
"The findings from these comprehensive claims analyses provide compelling evidence that effective cost avoidance measures are readily available and should be implemented within existing state, federal and commercial program structures. Healthcare reform efforts must recognize and address the problem and significant costs of uncoordinated care if there are going to be 'real' and 'meaningful' changes to the healthcare delivery and payment systems."
More information on this study and on focusing care coordination resources can be found be clicking here.
To arrange for a discussion review of this study and approach, feel free to contact either Nandan Kenkeremath at firstname.lastname@example.org (703-407-9407) who is assisting in policy development and outreach regarding this work or Mary Kay Owens at email@example.com (850-668-8524 ext 107) President of SEC and primary author of this study and approach.
Southeastern Consultants, Inc. is a national pharmaceutical and health care consulting and data analysis firm providing services to health plans, benefit managers, employer and provider groups, government agencies, associations, medical and pharmaceutical, disease management organizations, and academic institutions. For more information about SEC and their services, please visit the web site at www.sec-rx.com.