The U.S. health care system is often described as one that fails to achieve optimal health outcomes while generating exorbitant costs for patients, payors and society.
The Institute of Medicine (IOM) estimates that $750 billion—30% of the U.S. annual health care budget—is wasted on unnecessary services, inefficient delivery, excessive administrative costs and prevention failures. Barriers to patient access, fragmentation of acute and chronic care, ineffective management of chronic illness, and complex, outdated reimbursement processes leave patients, clinicians and payors frustrated at historic levels.
A special problem: 24/7 coordinated out-of-hospital care. The discontinuities of health service are notably evident in the care of patients at home; this is particularly true for the chronically ill, frail elderly and mobility impaired. Multiple single-purpose providers offer niche care and often only during restricted hours of operation, neither of which match the actual needs of this patient population.
As a result, patients are routinely referred to hospital emergency departments (EDs) by their healthcare providers, outside of normal business hours, despite the common knowledge that the ED is an imprecise match to their needs. Further, care gaps such as a lack of post-acute transitional care make preventable re-admissions a virtual inevitability that is both expensive and disappointing to patients, caregivers and the health care system.