Identifying High-Cost Patients Early May Help Lower Health Care Costs |
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Written by U.S. Insurance News
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Monday, 20 October 2003 |
Researchers at Lotter Actuarial Partners have developed a new solution to the nation’s health care cost issues.
NEW YORK – Researchers at Lotter Actuarial Partners have developed a new solution to the nation’s health care cost issues. They’ve proposed that costs imposed on the health care system could be greatly reduced by identifying those patients who are likely to undergo an expensive medical event early, and to take preventative action to lessen the costs.
"Our approach applies techniques from direct marketing. Marketers target those who are most likely to respond to their message," Ian Duncan, partner and risk management/risk prediction expert at Lotter Actuarial, said. "We identified patients who were most likely to have an expensive event, such as a hospital admission. Helping patients like that would save needless suffering and a lot of money that could go to help others."
Duncan pointed out that insurers may know more about patients than their physicians know.
"Your doctor gives you a prescription, but your insurer knows whether or not you have filled it," Duncan said.
Duncan is the lead author of “A Prediction Model for Targeting Low-Cost, High-Risk Members of Managed Care Organizations,” which won the Disease Management Association of America award for best article of the year on management of chronic illness. The article was published in The American Journal of Managed Care in the May 2003 issue.
Along with two of his colleagues, Henry Dove, Ph.D. and Arthur Robb, PH.D., Duncan identified people who had not yet, but were likely to, require expensive health care within six months to a year by studying claims information.
"The Holy Grail is to identify people who will cost the health care system a lot of money, then intervene to prevent problems and reduce expenses," Duncan said.
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