A focus on the costliest patients

Cost control has become the name of the game as the federal government, states, insurers and other payers struggle to get a handle on medical spending for the patients with the highest costs to the system.

American Medical News reported on several ways in which the entities paying the bills are trying to lower the price tag without cutting back too much. Putting a greater number of sicker, poorer patients who qualify for both Medicare and Medicaid into managed care plans looks promising to some states. Governors and health plans are pushing prevention efforts aimed at lowering chronic disease rates through healthier behaviors. And new federal research tries to identify the top 1% of costliest patients who are accounting for 20% of the health spending.

Resistance builds to managed care for dual eligibles

Dual-eligible patients, who qualify for both Medicare and Medicaid, often have multiple health conditions that cost the federal and state governments a significant amount of money. Using federal waivers to move more of these patients into managed care could cut down on the costs, but the moves are facing a backlash from physicians who say the dual-eligible population is too sick and vulnerable to undergo such a shift without serious access-to-care problems. Read more

States target chronic disease to trim health care costs

States’ chief executives have found themselves on opposing sides in the fight over the national health system reform law, but the governors do agree that tackling chronic disease is a key aspect of keeping health costs down. At a recent National Governors Assn. meeting, states shared promising ideas about promoting early health interventions — with the help of insurers — to stop serious conditions before they start. Read more

Who are the chronically costly? Health care’s 1%

The federal Agency for Healthcare Research and Quality released new data in January that give insight into the patients who are incurring disproportionate amounts of health care spending. The report reveals that the typical member of the top percentile of costliest patients is an older, privately insured, white female who has a relatively higher income and multiple health conditions. Read more