Privacy laws prevent U.S. employers from looking at the details of their employees’ medical spending. So they hand their health-care payment data over to companies that analyze the patterns and tell them how to reduce their health-insurance spending. Mostly, these companies give financial advice on changing benefits—telling them, say, to increase employee co-payments for brand-name drugs or emergency-room visits. But even employers who cut benefits find that their costs continue to outpace their earnings. Verisk, whose clients pay health-care bills for fifteen million patients, is among the data companies that are trying a more sophisticated approach.
Besides the usual statisticians and economists, Verisk recruited doctors to dive into the data. I met one of them, Nathan Gunn, who was thirty-six years old, had completed his medical training at the University of California, San Francisco, and was practicing as an internist part time. The rest of his time he worked as Verisk’s head of research. Mostly, he was in meetings or at his desk poring through “data runs†from clients. He insisted that it was every bit as absorbing as seeing sick patients—sometimes more so. Every data run tells a different human story, he said.
At his computer, he pulled up a data set for me, scrubbed of identifying information, from a client that manages health-care benefits for some two hundred and fifty employers—school districts, a large church association, a bus company, and the like. They had a hundred thousand “covered lives†in all. Payouts for those people rose eight per cent a year, at least three times as fast as the employers’ earnings. This wasn’t good, but the numbers seemed pretty dry and abstract so far. Then he narrowed the list to the top five per cent of spenders—just five thousand people accounted for almost sixty per cent of the spending—and he began parsing further.
“Take two ten-year-old boys with asthma,†he said. “From a disease standpoint, they’re exactly the same cost, right? Wrong. Imagine one of those kids never fills his inhalers and has been in urgent care with asthma attacks three times over the last year, probably because Mom and Dad aren’t really on top of it.†That’s the sort of patient Gunn uses his company’s medical-intelligence software program to zero in on—a patient who is sick and getting inadequate care. “That’s really the sweet spot for preventive care,†Gunn said.
http://www.newyorker.com/reporting/2011/01/24/110124fa_fact_gawande?currentPage=all
Very long article about looking at managing health care cost from a different approach.
My thoughts:
I believe it carries an interesting argument that the health care system of "right now" could be doing a lot better, but the changes maybe they shouldn't be so drastic.
Just FYI.
This article takes a while to read and to understand. I would like to hear your thoughts about said article.