Using an Input-Throughput-Output Model to Minimize Cost, Increase Value

Authors of an article published in Health Affairs argue the pressure for diagnostic accuracy and overuse of tests and resources are the main barriers to containing cost in the acute-care setting, but interventions at the input, throughput and output points of the system may help reduce these costs.

The authors identify the input point essentially as the demand for acute care. This includes critically ill patients, safety net care and unscheduled acute care. Throughput refers to what healthcare providers actually do with a patient and output is how patients move to the next phase of their care.

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Input — The authors suggest two mechanisms to reduce the need for acute care: prevention and setting substitution.

Prevention includes any intervention that may prevent the need for acute care, such as vaccination programs, public health initiatives and disease management programs. The effectiveness of these programs depends on implementation efforts, note the authors.

Setting substitution aims to encourage patients to seek care from a setting appropriate to his or her condition, mainly moving low-acuity events from emergency departments to clinics or primary care offices. Educational initiatives to help guide patients' decisions on where to receive care, new retail or urgent care facilities and financial incentives like requiring co-pay at emergency departments may help reduce emergency department volume, the authors say.

Throughput — Changing physician behavior and overuse of resources is one of the largest components of reducing costs, according to the authors. They say the first step to implementing change is having physicians make cost containment a priority. The authors suggest doing this by using the electronic health record as an evidence-based decision tool or making sure proposed treatments fall in line with the patient's desired overall care plan.

Output — Telemedicine is proving to be an effective tool to monitor patients at home and extend the length of the physician-patient relationship, thereby reducing the need to admit patients to an ED as a precaution. The authors also suggest "observation status" units for patients to monitor their condition before deciding if an ED admission is necessary.

The authors of the report are Jesse Pines, MD, director of the Office of Clinical Practice Innovation and professor at George Washington University in Washington, D.C.; David Newman, MD, director of clinical research and associate professor of emergency medicine at Icahn School of Medicine at Mount Sinai in New York; Randy Pilgrim, MD, CMO of Lafayette, La.-based Schumacher Group; and Jeremiah Schuur, MD, chief of the Division of Health Policy Translation and director of quality, patient safety and performance improvement at Brigham and Women's Hospital in Boston.

More Articles on Healthcare Costs:

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Survey: CFOs Optimistic But Concerned About Healthcare Costs
Massachusetts Hospitals Must Provide Cost Estimates to Patients

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