Another One Percent is Making Headlines

– In Tomorrow’s Healthcare System, Skilled Case Managers Will Be in Demand –

AURORA, Colo. – March 13, 2012 – Between the Occupy Wall Street movement and the election season frenzy, it would be easy to miss the recent focus on the so-called “one percent” (those individuals among the super-rich who make up a tiny fraction of the population but hold the lion’s share of the nation’s collective wealth). But now there’s another one percent, and it’s a group to which no one aspires to belong: the super-sick.

Barely one percent of the population accounts for about 22 percent of our country’s inflated health care spending, according to a recent statistical brief from the Agency for Healthcare Research and Quality (AHRQ).

In 2009, each individual in this top one percent spent about $90,000 a year on health care, and it’s estimated that the 2011 figures (not yet available) are about $115,00 per person – all this in an era where our median household income is just over $49,000, according to census figures.

Five percent of the population accounts for 50 percent of total health care costs, or about $50,000 per person, according to the AHRQ brief.

And on the flip side, 50 percent of the population used health care resources infrequently, accounting for only 2.9 percent of total spending. Members of this group spent only $360 a year each, on average.

This is turning into a basic conundrum of our health care system, that resources are allocated so disproportionately. Low health care spenders, according to the report, were more likely to be uninsured, most likely because they are healthy and choose to forego insurance.

The largest driver of health spending by far is care provided to those who are old or chronically ill. Common sense tells us there’s no way to change this. But, with an eye toward this newly defined “one percent,” what can be done to reduce spending among their ranks?

Accountable Care Organizations

Dr. Catherine Garner, DrPH, MSN, RN, FAAN, dean, health sciences and nursing at American Sentinel University, says that ACOs’ impact will be positive for nursing, as they provide expanded opportunities for nurses to become managers of care rather than just providers of care.

One of the goals of accountable care organizations will be to reduce unnecessary hospital readmissions – those defined as occurring within 30 days of a discharge and being directly related to the original complaint.

Often, readmissions within this 30-day window are the result of avoidable complications. For example, congestive heart failure alone has a readmission rate of 27%, according to a 2009 study in the New England Journal of Medicine.

And according to the Medicare Payment Advisory Commission (MedPAC), in 2005, 17.6% of all Medicare patients were readmitted within 30 days, for a cost of $15 billion.

What does all this mean for nurses?

ACOs need credentialed experts in case management to coordinate the care of those with chronic illness and ensure that they receive the most appropriate level of care at the best time and cost.

“Nurses with education in case management who can manage clients across the continuum of care will be in great demand – managing not only the patient, but the family, the community and more,” Dr. Garner said. “Nurses need to understand the care provided at all levels of the continuum, the maximization of insurance payments, negotiating with medical supply and pharmaceutical providers as well as the support and engagement of family members.”

In tomorrow’s healthcare system, where discharge planning takes on an urgency not seen before, skilled case managers will be in demand.

At most hospitals, a squadron of case managers will be involved with all patients, assessing them in person and beginning the process of discharge planning as soon as a patient is admitted.

“Case management is an excellent career path for nurses wanting to play a leadership role as health care reform evolves,” says Dr. Garner.

Online nursing degrees like American Sentinel’s MSN with a case management specialization can make nurses attractive to employers, provide student’s with case management knowledge and skills and provide the academic background needed to pass the credentialing exam.

American Sentinel University is one of only five MSN programs in care coordination and this two-year online program is ideal for hospital nurses who want to expand their scope of practice and position themselves as future care coordinators. It is also an excellent credential for those nurses who have been practicing case management and want to improve their marketability.

Read more about American Sentinel University’s Master of Science Nursing, Case Management Specialization or call 866.922.5690.

You can also read more information about American Sentinel University’s CCNE-accredited online nursing programs.

About American Sentinel University

American Sentinel University delivers the competitive advantages of accredited online degree programs in nursing, informatics, an MBA Health Care, a DNP Executive Leadership and a DNP Educational Leadership. Its online, affordable, flexible bachelor’s and master’s nursing degree programs are accredited by the Commission for the Collegiate Nursing Education (CCNE). The university is accredited by the Distance Education and Training Council (DETC). The Accrediting Commission of DETC is listed by the U.S. Department of Education as a nationally recognized accrediting agency and is a recognized member of the Council for Higher Education Accreditation.