The One Percent in Healthcare – Can Hospitals Make It Personal?

by April Sciacchitano (@aprilcs)

H&HN recently reported on the costliest one percent of patients.  They comprise 20 percent of healthcare spending, and visited the emergency room about 10 times in the past year. 

Meanwhile, healthcare is on a mission to reduce costs and improve outcomes – and any solution that can do both at once is a priority. It seems as if the patient can’t lose in this situation, but that’s not always the case. In fact, Doug Eby, MD, vice president of medical services for Southcentral, makes an assertion that would have any hospital CEO cringing:  that healthcare thinks of itself as a manufacturing industry.  According to Eby, hospitals have fallen in love with Six Sigma and Lean, thinking the right process will cause healthy living to “break out.”  It’s that thinking that has left no room for personalized, patient-centered.

However, personalized care can do a lot to help this costly 1 percent manage their health (and become less costly). Hospitals like Southcentral Foundation  in Anchorage, Alaska are “hotspotting” these patients by identifying common factors – a neighborhood, a behavior or a condition – and addressing this population.  In addition, hospitals are finding success by identifying a few caring staff to work with repeat patients.  This one on one time allows staff to educate patients, but also learn what lack of knowledge or resources lands them back in the emergency department. 

Unfortunately, this kind of personalization may be on the decline. In the rush to make our health systems more efficient, the focus is on standardization and evidenced-based practices – treat us all the same, and you’ll see better outcomes. This is ultimately an important strategy, but does not have to go hand-in-hand with depersonalization of care. In a recent panel on personalized medicine, Dr. Ezekiel Emanuel, chairman of the Department of Medical Ethics and Policy at the University of Pennsylvania, suggested personalized medicine is a myth – and that tailored medical treatment is simply cost prohibitive.  Personalized care, however, doesn’t have to be.

Personalized care is not only an opportunity for hospitals to hone in on the one percent, but also to differentiate themselves.  The biggest innovations in care from the patient perspective are simple:  a new hospital gown that takes their privacy into account, a nurse navigator that will manage their care from the very beginning, a better way of communicating with their doctor.  Some of these “user experience” considerations are still a novelty in healthcare. Hospitals can be too risk-averse to innovate at this level, but find success engaging other industries.

As healthcare continues to change, we may forget how personal and individualized health is. Part of decreasing the cost of care really can be connecting with patients on a human level.  Better health and lower costs can go together if hospitals think more about how to change and deepen their relationships with patients.

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