Between the Occupy Wall Street movement and the election season debates, it would be hard 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. Well, there’s another one percent now, and it’s a group that no one aspires to belong to: 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) reports that. 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, the brief stated.
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.
Here are the characteristics of the top ten percent of health care spenders:
- Sixty percent are female
- Forty percent are 65 or older; only three percent are in the 18 to 29 age group
- Eighty percent are white; only two percent are Asian
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 are looking to address some of this runaway spending by improving preventive services and better coordinating care that’s traditionally been far too fragmented. 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.
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 appears to be an excellent career path for nurses wanting to play a leadership role as healthcare reform evolves. Online nursing degrees like American Sentinel’s MSN with a case management specialization can make you attractive to employers, provide you with case management knowledge and skills, and give you the academic background you’ll need to pass the credentialing exam. American Sentinel University is an innovative, accredited provider of RN to BSN and RN to MSN degrees.