A study presented at the annual conference of the American Society of Addiction Medicine found that incorporating substance abuse care into a population health management system can assist in raising patient retention numbers, reducing visits to emergency room departments, and slash healthcare costs on the average of 46 percent.
Humana Study Data
Humana, with its headquarters based in Louisville, Kentucky, is a leading health company focused on assisting individuals to achieve heath through coordinated care and clinical excellence.
A Population Health Management (PHM) system was a key aspect of the Humana study. PHM is a grouping together of patient data from a number of health information resources, and analyzing that data into a single patient record.
PHM seeks to improve health outcomes of a specific population (group) by identifying and monitoring individuals within that population. Business intelligence (BI) tools are used to gather and combine data, and provide a comprehensive picture of a patient. Healthcare providers use that data to track outcomes with a view towards treatment improvement and lower costs.
More than 2300 Humana patients were involved in the study, with 151 of them selected to participate in a program for substance abuse management. Analyzing data from patient claims history and pairing it with a control group, patients who may have an overlooked substance abuse problem were flagged. Factors taken into account included inpatient hospital admission and average number of visits to the emergency department.
The study participants enrolled in this population health management program integrating treatment and help for substance abuse reported fewer visits to the emergency department (16%), and markedly fewer hospital admissions (67%) than did the control group. Moreover, patient enrollment in the health management program remained greater than the 10.9% national average.
An Overview of the Situation
Healthcare providers and lawmakers alike have intensely scrutinized substance abuse, especially controlled substances such a prescription opioids, in efforts to better monitor and reduce doctor shopping and other fraudulent substance-abuse related activities.
Prescription Monitoring Programs (PMP)and expansion of state-level databases provide real-time access to patient’s habits, and the healthcare industry and government officials are partnering in efforts to prevent substance-abuse related crimes, overdose deaths, and other adverse events.
The Humana study data aligns with a healthcare industry viewpoint that patient-centered care and improved population health management (PHM) has the potential to impact the manner in which patient’s cope with chronic pain and other difficult health issues that may lead to opioid abuse and addiction.
According to University of California David Geffen School of Medicine professor, Dr. David B. Reuben, there is “inadequate knowledge” regarding treatment of types of pain, and how to balance the effectiveness with potential harms. He notes the current healthcare delivery is dysfunctional in its promotion of “the easiest rather than the best” approach to dealing with pain.
Study Findings and Results
It was found that the Humana study participants received better care, helping them to avoid crisis events. It also markedly reduced patient’s healthcare costs with an average drop of 46 percent. In comparison, the control group costs increased 14 percent at the same time.
According to Chief Medical Officer for LifeSynch, Dr. Larry Weinstein, the improved health outcomes reflected benefits that a PHM can achieve through “integrating substance abuse programs”, thus taking a proactive approach to reach individuals at risk of medical or mental complications from substance abuse.
At the same time, it is important to maintain the individual patient’s right to privacy, and power of choice in determining what medical, mental or substance abuse treatment the person wants—or does not want. Depersonalization is a very real risk of basing treatment decisions solely on technology and databases