To reduce costs, health workers move toward more contact with patients

The days when doctors simply waited for sick people to walk into their clinics are done. Many patients with chronic diseases now find themselves in contact with clinic-employed health coaches who nudge them to take their medications, eat right, be active and assume ownership of their health. These efforts go well beyond previous patient outreach, in part because they are increasingly tied to insurance payments. The goal is to reduce costs by rewarding providers more for keeping groups of patients well rather than simply for office visits and procedures. Clinic decisions and costs also are tracked better as electronic medical records become more widely adopted.

Mark Warner, a 48-year-old Elkhorn-area resident, recently received a hard diagnosis — diabetes — that resulted in a meeting with Shelley Miller. She is a registered nurse who serves as his care coordinator and health coach at the Alegent Creighton Clinic's 204th Street office. She and Warner talked for 30 minutes about the disease, medications, carbohydrates, the device that measures blood sugar and the ways to stay on top of diabetes. He said he intended to resume intense cardio workouts. “You sound very motivated,” Miller said. “I am.”

Diabetes is a frequently highlighted disease in efforts to control health care costs and improve patient health. Extra attention is directed at such chronic-disease sufferers because their hospitalizations, emergency-room visits and other costs account for huge amounts of the United States' medical expenditures. The Centers for Disease Control and Prevention said that in 2009, more than 75 percent of health care costs were attributable to chronic conditions such as diabetes, heart disease, high blood pressure and chronic obstructive pulmonary disease.

Early results locally indicate the new direction in health care may achieve the dual goal of keeping patients healthier while lowering medical costs: Methodist Physicians Clinic administrators say their efforts help keep diabetics' blood sugar and other measures at acceptable levels. Seventy-four percent of their diabetics were managing their disease well this spring, they said, up from 50 percent in early 2012.

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