Demonstrated Health Improvement & Cost Savings in the most Expensive Patients

Further Application of Technology make Huge Cost Savings Attainable and Expand Access to Care According to a November, 2020 article in the Harvard Business Review https://hbr.org/2020/01/managing-the-most-expensive-patients, Kaiser Permanente and a few companies are finally cracking the code on how to lower health care costs and improve patient care. Compelling data on cost savings and patient outcomes have been established in these programs. One key is in understanding the breakdown of the highest cost patients, and in which groups a program can be most effective. The second key is to shift the focus from a disease management program to a leveraged primary care approach using technology to pivot to a preventative stance, lowering the number of patients that enter the high cost group in the first place. Further gains can be made in terms of cost savings and expanded access to care by utilizing technology such as the Sirona Health device.

KPs program resulted in: • 10-15% lower premiums • higher margins • ability to fund capital investments in excess of $1 billion per year • consistently ranking among to 5 in nation for quality Other companies using the approach had similar results: • excellent quality at lower costs • fewer complications • patients avoided developing new complications

• 20-50% fewer ER and hospital visits

When considering how to bend the cost curve of health care, much of the attention is given to the most expensive 5% of patients. This group of 5% of the population accounts for 50% of all healthcare spending, but many do not realize that this 5% is comprised of three, roughly equal groups. The profile of these patient groups are quite different, so require a different approach.

The first group is made up of people with one or more chronic medical conditions that could be improved or kept under control. These conditions include diabetes, stable heart failure, asthma, and mental illnesses. It is within this group that companies have been able to effect the most change on outcome and expense by using technology and relatively inexpensive medical staff to provide expanded support to primary-care doctors. The second group are people who suffer a one time catastrophic health problem. These events include a major trauma, and extremely premature birth, or a sudden life threatening illness such as acute cancer. This group accounts for about 35% of the total spent on the 5% in a single year. Because these catastrophic health events cannot be predicted, there is very little that can be done to prevent them.

The third group is comprised of people with severe chronic conditions who cannot be returned to good health and require expensive treatment continually. These patients have conditions such as severe heart failure and chronic renal disease and require expensive ongoing treatment every year. Some of these were in the first group years before and deteriorated. In most cases little can be done to bring them to good health or avoid large medical bills. This group also accounts for about 35% of the dollar spent of the 5%. The opportunity for cost savings lies within the first group of patients with the manageable chronic conditions. These people account for just 30% of all the money spent in the top 5%. The people in this group change every year, so cost savings programs would need to include patients that may end up in that group.

In analyzing patients who might end up in that group, of the nation’s 55 million Medicare members over the age of 65, roughly 27.5 million have five or more chronic conditions that could be kept under control with proper care. 4 to 5 million of them join the first group of patients who are in the top 5% in spending in any given year. To achieve maximum success, a care program should include all 27.5 million and the cost to treat these patients with the traditional disease management program would not be economically feasible.

The Sirona Health device can provide a low-cost way to improve the health practices of this group so that they avoid falling into the current chronic care group. Sirona Health can upload healthy lifestyle videos and programs directly onto the television of it’s patients. Healthcare programs could load specific videos and protocols based on the patient’s chronic care condition. Sirona Health canremotely monitor the patients participation and progress with certain health metrics, such as blood pressure and weight. For example, when prescribing a blood pressure medication, it is helpful for the doctor to have multiple blood pressure readings to ensure the right medication and dosage. The patient can perform these easily with the Sirona Health device, where the blood pressure apparatus is blue tooth enabled and the data is automatically uploaded to the doctor’s office.

The disease management model employs relatively highly paid people to perform many services that do not require their skills such as screening databases, arranging laboratory services and radiology tests, obtaining information on the individual subjective view of his or her health, asking whether the doctors plan is being followed and extracting the data needed to see if outcomes match the physicians expectations. All of these functions can be automated using the AI technology and virtual assistant of Sirona Health.

The virtual assistant can prompt the patient to perform daily health tasks such as take medications and participate in certain health practices, such as an exercise or meditation video, and take health measurements. The health measurement data is automatically uploaded to the doctor’s office. The AI technology and virtual assistant can also be used to arrange doctor’s appointments, reorder medication, arrange laboratory services and tests and to help the doctor ascertain whether the health plan has been followed by providing patient data directly to the physicians office.

KP and the other companies are beginning to use technology to perform some functions of the medical program, such as send text messages remind patients about preventative screenings. These technologies help address new medical problems and re-avoid readmissions, but can be further enhanced with the use of Sirona’s virtual assistant and AI functionality. In addition, many patients who experience chronic care conditions do not use smart phone technology, Sirona health allows patients to interact using their TV remote from the comfort of their living room or bedroom, thus eliminating the technology barrier and broadening access to patients.

This new understanding of in which groups medical programs can be most effective, coupled with the use of scalable technology, put controlling health care costs and improving patient care within reach. Automating care functions in an easy to use, patient friendly interfaces eliminates the need for costly manpower, and dramatically improves care and access to care. Suddenly, a broad reaching program that is simple to implement for millions is possible.

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