More Is Not Better – The Story of Fragmentation of Care

More Is Not Better – The Story of Fragmentation of Care

Nov 4th, 2009 | by Craig Thiele, M.D.
Category : Efficiency and Quality



It’s the Fragmentation, People

I heard a story that didn’t surprise me, but may surprise you, especially if you haven’t heard much about fragmentation of care. It was called “The Telltale Wombs of Lewiston, Maine,” on National Public Radio. At the start, the story seemed to be pointing a finger at doctors for providing services (especially surgeries) that their patients don’t really need, sometimes with negative results. This point of view has been around awhile, and frankly, does not do justice to a complex situation.
In the end, here’s what I heard that concerned me:

“(Dr.) Elliott Fisher…compared Medicare recipients with similar levels of sickness in areas throughout the whole United States. Fisher looked at places where elderly people used relatively few health care services and compared them with places where elderly people used a lot of health care services.

‘The patients in the high-spending regions were getting about 60 percent more care; 60 percent more days in the hospital; twice as many specialist visits,’ Fisher says. ‘And yet when we followed patients for up to five years, if you lived in one of these higher-intensity communities, your survival [rate] was certainly no better, and in many cases a little bit worse.

This is probably because of something called fragmentation of care. In high-use areas, it’s often the case that many different doctors play a role in the care of a patient; many specialists are responsible for overseeing only a small part of the person. This increases the amount of treatments, tests and hospitalizations that people get, and exposes people to more risk of harm from medical error and side effects.”

For most Americans, fragmentation of care is a difficult idea to accept: It’s hard to understand that more care isn’t necessarily better for you.

But study after study has borne out the truth of this completely anti-intuitive conclusion. In fact, Fisher and other researchers estimate that almost one-third of the care given in our country today is that kind of care — care that may not help.

In some studies, it is estimated that the United States spends more than $2 trillion on health care every year. If 10 percent of this care provided is unnecessary, this would cost $200 billion. Some estimate it may be as high as 30 percent, or roughly $600 billion.

What lesson should we take from this about health care reform overall? It seems to me that whatever the final form it takes, reform must confront and solve these issues, including fragmentation of care. Whether we go with “exchanges,” “co-ops,” a “public option,” Medicaid expansion, or a combination of all of them, attention must be paid to avoid fragmentation by coordinating care.

It seems too obvious to point out that non-profit insurers like CareSource have been improving outcomes and controlling costs through care coordination for years now. We certainly hope that Congress, in its wisdom, will put that experience to work.

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3 Responses to “More Is Not Better – The Story of Fragmentation of Care”

  1. Keith Magee says:

    I don’t totally disagree – some folks are simply over-medicated and over treated. Often all these people need is expert advice – not an office visit, ER visits, or even more office visits. I found a website (www.callmd.com) which offers 24/7 “triage” with a real trained nurse, who will even arrange to have an MD call you back if you have something serious enough to warrant it. You can also get office visits, dental exams, and vision care at rates equal to the best rates available only through large Fortune 500-type healthcare benefits programs…. yet it costs less than $40 per month for my family of four. No – I am not an employee, sponsor, or owner of CallMD – just a very satifsfied customer. Now rather than paying $1000 per month for medical insurance, I have taken out a Blue Cross plan for half that amount that covers hospitalization, and my “day to day” healthcare needs are now affordable again.. and I save about $400 a month! This I think, is the kind of reform we need… more private initiatives that do the job, create jobs, and save lives and money!

  2. I’ve seen the good that you guys do and wish more people would be singing your praises! If they were then people would know that the public option is something that with the right leadership and structure could really work in this country! Here’s a great video that seems to really cut through the rhetoric to make it easier to understand. http://cli.gs/bLJzD8

  3. I’ve seen the good that you guys do and wish more people would be singing your praises! If they were then people would know that the public option is something that with the right leadership and structure could really work in this country! Here’s a great video that seems to really cut through the rhetoric to make it easier to understand. http://cli.gs/bLJzD8

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Article References

  • The whole story on NPR
  • National Public Radio
  • Harvard Study on Health Care Fragmentation; 2008
  • Cost of Health Care in the U.S.; Kaiser Family Foundation Study
  • What Are Health Insurance Exchanges?
  • What Are Health Insurance Co-ops?
  • Side-by-side Comparison of health care plans
  • Author : Craig Thiele, M.D.

    Chief Medical Officer, CareSource Over 16 years of clinical leadership experience with a strong background in case and disease management. Oversees clinical and quality initiatives at CareSource and manages medical policy, clinical care guidelines, utilization parameters, and quality assurance for its health plans.