That's such a substantive entry at wonkblog it's amazing it's not an article in an old-skool pub -- just goes to show where we're headed, I guess.
Anyway. If you're thinking, hey! We'll revisit what Oregon did under Clinton, no, not really. This is a much more recent initiative, but it's operating under the same kind of principle: let's save money by not supplying expensive care which is bad for people, and by avoiding having to supply lifesaving expensive care by catching problems earlier in the process. This one has a new twist: get some behaviorists in to figure out why some of the frequent flyers aren't doing better self care.
"Goldberg says that a small experiment in Oregon last year gave the state clues about a better way to reduce health spending. It took place at St. Charles Hospital in Bend, a mountain town known for its snowboarding, white-water rafting and microbreweries.
St. Charles noted that 144 patients tended to use the emergency room the most. Taken together, they averaged 14.25 trips each over 12 months. These patients drove much of the area’s Medicaid spending."
Yeesh. They fixed some bureaucratic obstacles, and incorporated some mental health workers:
"Behavioral health specialists were embedded in clinics that traditionally dealt only with physical issues, in order to give patients a point of contact when they walked in the door.
The program was not a complete success. Of the 144 patients in the study, only 62 percent agreed to work with a community worker on a plan for their care. The others proved difficult to track down or did not want to participate."
But they did save a bunch of money overall, enough to encourage the state to try it on a larger level.
Over at Providence Health: "Van Pelt notes that he has had to oversee workforce reductions, as the hospital has become more efficient. His providers, for example, started a program to reduce elective Caesarean-section births before 39 weeks, which can lead to costly medical complications. Fewer babies ended up in neonatal care and, suddenly, a smaller neonatal staff was needed."
Best Reason Ever to Lose Your Hours/Job, amirite?
Some stuff later on about a woman with a major social anxiety problem and helping stabilize her in a community. Some stuff about having a proactive approach to using mental health workers.
All good news, really, but definitely the kind of thing that makes you go, Where Is the Adult Supervision?