TY  - BOOK
AU  - Pearl, Robert.
TI  - Managing the most expensive patients: a new primary-care model can lower costs and improve outcomes 
PY  - 2020///
KW  - Access to health care
KW  - Health care reform
KW  - Health services administration
KW  - Medical care -- Costs
KW  - Medical care -- Quality control
KW  - Medical policy
N1  - Business
N2  - Discussions about reining in health care costs invariably turn to the sickest 5% of the population, who account for 50% of all health care spending. Many of these patients have multiple chronic conditions, and the hope is that through disease-management programs that use registered nurses and social workers to monitor and help them, we can care for them better and achieve big savings. But these programs are expensive. Typically each focuses on just one disease, which means that many patients deal with multiple teams. The programs also operate outside primary-care practices, so they often duplicate doctors’ work as well. And in the experience of the authors, the former CEO and associate executive director of Kaiser Permanente (KP), they do not reduce net costs. KP has come up with a better approach: providing coaching and support to patients through IT and inexpensive assistants who are integrated into primary-care practices—avoiding duplication. KP applies it judiciously, focusing only on patients whose chronic conditions can truly be improved (about a third of the most expensive 5%). This strategy has not only led to better medical outcomes but cut costs so much that KP has been able to offer millions of members premiums that are 10% to 15% lower than competitors’
ER  -