Years ago, HealthCare Partners identified a set of diseases -- including kidney failure, heart failure, diabetes, asthma, and chronic obstructive pulmonary
disease (COPD) -- that lead to a huge portion of their health expenditures. They were also predictable, so that a standardized approach to patient care was
likely to improve health and control costs for most patients.
For example, patients with COPD are taught key symptoms and signs of their condition so they can accurately alert their clinician when they experience
meaningful changes to their health. Changes in their breathing, or a new cough, may suggest a need for early medical intervention.
Cancer, in contrast, is such a diverse set of diseases, with so many different approaches to treatment, that it belies management by a protocol-driven
system. HealthCare Partners generally pays the bills and leaves the treatment planning to individual oncologists.
Dying, however, is subject to a protocol, and the HealthCare Partners palliative care program is widely admired for the flexible way the company arranges
for patients to receive end-of-life care at home, where an overwhelming percentage of patients say they prefer to die. Nationwide, more than 40 percent of
elderly patients die in the hospital; only 18 to 20 percent of Medicare patients in the HealthCare Partners system die there. Of course, it is not
coincidental that it is vastly less expensive for patients to die at home than it is for them to die in the hospital.
Just as HealthCare Partners works to keep patients out of the hospital, a well-calibrated team of hospitalists -- doctors who do nothing but care for
patients who are admitted -- works on getting patients who require inpatient care well and home as quickly as possible.
For anyone who has been hospitalized with a serious condition that isn't life threatening, the slow pace of diagnosis and treatment can be maddening. Many
hospitals turn in impressive results when speed matters -- such as when patients arrive in the emergency department with a blocked coronary artery -- but
when speed is unimportant, hospitals function on a different clock. Hours pass between when a physician orders a CT scan and when the CT scan is performed.
More hours pass before a radiologist interprets the CT scan images, and more hours pass between when the radiologist's report is available and when the
physician who ordered the test in the first place has a chance to review the findings and plan treatment. As hours blend into days, the bill adds up.
HealthCare Partners' response to this is a specialized team of 100 hospitalists, who are deployed at the 30 Los Angeles-area hospitals where HealthCare
Partners admits patients. These hospitalists are not above paging a radiologist to interpret a MRI that was recently completed, or going to the bedside to
make sure that an ordered medication is hanging on the bedside IV pole. As a result, the average length of stay for HealthCare Partners' patients is 3.3
days, compared to the national average of approximately six days. At $3,000 per day, that's a savings of more than $8,000 each time a HealthCare Partners
patient is hospitalized. The system, says Dr. Tyler Jung, HealthCare Partners' corporate medical director, "is really a maturation of 25 or 30 years of
looking for ways in which you optimize what you do in the hospital."