The First Step To Reducing Avoidable Utilization

Thursday, October 14th, 2010
This post was written by Jessica Fornarotto

Some simple analysis before launching a chronic care management program can help an organization to reduce avoidable utilization, advises Ariel Linden, Dr.P.h., M.S., and president of Linden Consulting Group.

Believe it or not, few organizations ever do a needs assessment. Often, they decide it makes sense to do a program for chronic heart failure (CHF) because CHF appears to have the largest ROI. However, if you don’t have any CHF patients in your population, then it doesn’t make any sense to implement a CHF program. First, you have to ask some basic questions about the makeup of the population. Then, ask what the utilization looks like in this population. If you have a well-managed population, it may not make sense to develop a disease management program because your providers are doing a good job. Focus on the acute utilization profile in your population and how much of that utilization is avoidable. For example, you could have acute utilization, but because everyone is end stage, there’s very little of that you could reduce, unless you triage everybody to an end-of-life program.

If your goal is to improve clinical measures — if there’s opportunity to expand that — then conducting a Numbers Needed to Decrease (NND) analysis is important. If you do not make a person self-efficacious and able to handle their own disease self-management and teach them how to interact with their healthcare system, they will not know what to do in an emergency. They will end up in the ER and after that, in the hospital. To determine whether there is an opportunity for an ROI, you need to do two things. First, do an NND analysis. Look at your rates for utilization — how much a program costs — to see if there is an opportunity to reduce it by the admissions to an extent, based on how much it’s going to cost you to implement the program and whether it’s internal or external. You also need to do some sample size and power calculations.

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