Coordinated Care and Member Engagement Help Lower Health Care Costs

By Michael W. Cropp, M.D. 

A new report from the Centers for Medicare and Medicaid Services (CMS) shows health care costs are rising. CMS said health spending in the U.S. will have reached $3.1 trillion – or $9,695 per person – in 2014, representing the biggest increase in five years.

CMS also projects spending will increase 5.8 percent annually from 2014 through 2024, due in part to more Americans gaining coverage through the Affordable Care Act (ACA).

Providing a greater portion of the U.S. population with access to care, one of the goals of the ACA, is something we can be proud of.  But, simply providing coverage doesn’t lower costs or necessarily improve a person’s health – ACA’s other goals.

CMS Administrator Andy Slavitt got it right when he said, “The task ahead of us is to keep people healthier while spending smarter across all categories of care delivery…”

It’s not just about providing coverage; it’s about providing coordinated care along with resources to help individuals engage in healthier behaviors, both of which lead to lower costs. Quite simply, better care costs less.

New York State recently approved Independent Health’s small group and individual premium adjustments for 2016 as submitted – an average decrease of 15.6 percent for individuals and an average decrease of 6.2 percent for small groups – while maintaining the current level of benefits.

How are these decreases possible?

One reason is the great results we are seeing from efforts to collaborate with our physician partners, in particular The Primary Connection, an innovative physician-led approach to improve the way health care is delivered in our region, providing the highest level of care in the most efficient manner.

Participating physicians are focused on working more closely with specialists to better coordinate care, and on reducing the number of preventable hospital admissions and readmissions.

Through September 2014, The Primary Connection physicians have decreased potentially preventable hospital admissions by 17 percent. They have also decreased readmission rates by 25 percent, resulting in a $4.7 million savings alone.

Independent Health is also committed to providing individuals with activities and resources to help them better manage their health, such as our nutrition benefit.

By guiding our members toward better decision-making and partnering with providers to improve the coordination of care, we are making progress in the effort to help keep health care costs under control.

 

 

Michael W. Cropp, M.D., is president and CEO of Independent Health. This piece originally appeared in the Opinion section of Buffalo Business First on September 18, 2015