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Lowering costs for higher-cost medicare patients through better outpatient care may be limited
Date:6/26/2013

placement. These findings suggest that strategies focused on enhanced outpatient management of chronic disease, while critically important, may not be focused on the biggest and most expensive problems plaguing Medicare's high-cost patients."

The researchers add that their "findings suggest that a complementary approach to saving money on acute care services for high-cost patients may be to additionally focus on reducing per-episode costs for high-cost disease entities through clinical innovation and care delivery redesign."

(JAMA. 2013;309(24):2572-2578; Available pre-embargo to the media at http://media.jamanetwork.com)

Editor's Note: This study was funded by the Rx Foundation and the West Wireless Foundation. Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, etc.

Editorial: New Evidence Supports, Challenges, and Informs the Ambitions of Health Reform

Aaron E. Carroll, M.D., M.S., of the Indiana University School of Medicine, Indianapolis, and Austin B. Frakt, Ph.D., of the VA Boston Healthcare System, Boston University Schools of Medicine and Public Health, Boston, comment on the findings of this study in an accompanying editorial.

"These findings certainly do not suggest abandoning efforts to reduce preventable emergency department use and hospitalizations. Joynt et al do not consider the social cost of this utilization. Even though avoiding some emergency department use and hospital admissions might not save much moneyand certainly not enough to declare victory in controlling health spendingpreventing such use when possible would be of substantial benefit to patients, both those who would otherwise use these services and those who have their care delayed because of overburdened emergency department and hospital resources. Even with no cost savings, reduc
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Contact: Marge Dwyer
mhdwyer@hsph.harvard.edu
617-432-8416
The JAMA Network Journals
Source:Eurekalert

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