Sharp HealthCare is navigating the changing payer and provider landscape by banking on two words: care management.
“It’s a buzz word because it’s a potential solution that promises higher care at a lower price,” said Jerry Penso, medical director, continuum of care for Sharp Rees-Stealy Medical Group.
Care management’s goal is to optimize wellness and improve coordination of care via cost-effective, non-duplicative services. The way to get there is through prioritization (data mining and heath risk assessment), interventions (patient self-management), payment alignment (pay for performance and care management fees) and evaluation (return on investment and satisfaction amongst patients and physicians).
Penso held a panel to discuss care management at Biocom's La Jolla headquarters on Tuesday. The couple dozen attendees included reps from PricewaterhouseCoopers, health economics groups and Johnson & Johnson Pharmaceutical Research & Development.
As a result of the Affordable Care Act of 2010, new health delivery structures and payment methodologies have been introduced into the U.S. health care market that affect the way care is delivered and paid for.
“Health care costs are considered out of control and unsustainable. What are the options to fix that? Rationing and price controls – neither sound good to us,” he said.
One attractive option, he says, is to locate high-cost patients and figure out ways to prevent hospital visits.
“If I can reduce their spending to X percent, I can save real money,” he said, pointing out that emergency room visits can cost three to four times the amount of a private office visit.
Readmission among patients with heart failure, a top reason for hospital visits among seniors, was down at Sharp by 30 percent in 2009, thanks to a program that tracks one's health from their home.
Patients step on "home telescales,” which ask them heart-related questions and transmit the answers to nurses, acting as an early warning system to monitor at-risk patients. Medications can be adjusted based on answers, for example, to keep them out of a hospital.
“Patients have better care and aren’t ending up in the ER because their heart failure has acted up,” he said. “If you can prevent one heart failure admission you can already see the ROI.”
Penso calculates $2.5 million a year in savings by avoiding such admissions, he said.
Sharp’s positive track record for managing senior health while saving costs got it noticed earlier this year. Sharp was one of 32 companies across the United States picked to work on a pilot program for Medicare beneficiaries, called Pioneer Accountable Care Organization (ACO) Model.
The goal is to amp up engagement between patients and their medical providers in the coordination of care and services across all aspects of their health care needs.
“The goal for Medicare is to save money, us to make money and do things better at a cheaper price,” Penso said.
Sharp HealthCare, which captures 27 percent of the market share in San Diego, was founded in 1955 and includes seven hospitals.
10996 Torreyana Rd. Ste., 200
San Diego, CA 92121