To curb Arkansas' health care costs, state leaders need to understand how trauma can have long-lasting effects on children's use of medical services over their lifetimes, a New Jersey doctor told a state advisory panel on Tuesday.
Dr. Jeffrey Brenner, director of the Camden Coalition of Healthcare Providers, referred to research stemming from the Adverse Childhood Experiences Study, a survey of more than 17,000 patients conducted by the Oakland, Calif.,-based Kaiser Permanente health system.
Research based on that survey shows a strong connection between adverse childhood experiences, such as the death of a parent or physical or sexual abuse, and outcomes such as homelessness, obesity and the use of health care services, Brenner said.
"A lot of those things that we're seeing are really just symptoms of the rewiring of the brain and the things that happen to you if you're exposed to toxic stress from [age] 0 to 5," Brenner said. "These folks either end up in jail, they end up homeless or they end up in the health care system, or they end up in all three."
Brenner spoke via an audio connection to members of the Governor's Advisory Council on Medicaid Reform, a 40-member panel of state officials and health care industry and advocacy group representatives appointed by Gov. Asa Hutchinson to assist a legislative task force exploring possible changes to the state's Medicaid program.
Among the primary tasks of the Legislative Task Force on Health Care Reform is recommending a replacement of the private option, which uses Medicaid funds to pay for commercial insurance for more than 200,000 low-income Arkansans.
In calling on the Legislature to create the task force, Hutchinson cited concerns about the private option's cost and opposition by some legislators and others.
He said last month that he wants the advisory council to focus on "expanding the range of options" under consideration by the task force.
According to its website, the Camden Coalition of Healthcare Providers compiled claims data from three health systems into a database used to analyze patients' use of services.
That data show that 1 percent of the city's patients account for about 30 percent of its hospital expenses and that 20 percent of the patients account for 90 percent of the expenses, Brenner said.
One patient visited the hospital 324 times in five years, and another visited 113 times in one year.
The New Jersey coalition attempts to better coordinate the care for patients such as those. One patient was a 52-year-old woman with severe chronic obstructive pulmonary disease who visited the hospital eight times within a year, incurring $745,018 in medical bills.
A team from the coalition found that the woman didn't want to go to the hospital, but her family was "terrified" of the ventilator that the woman used to help her breathe at home.
"They needed more training on the machine, and then they needed the primary care physician and the pulmonologist to work together as a team," Brenner said.
Coalition staff members accompany patients to medical appointments and help with tasks such as finding a place to live and showing up for court hearings, Brenner said.
"It's cheaper for me to send someone to court with these patients or help them move into an apartment than it is to admit them to a hospital," which costs $10,000 per stay, Brenner said.
Advisory council member Joe Thompson, director of the Arkansas Center for Health Improvement, said Arkansas has made progress through its patient-centered medical home program, which makes up-front payments to doctors who agree to take steps to better coordinate patient care.
But the program isn't "all encompassing," he said. "I think we've done well on the medical side of the equation, but probably not on the social side."
Arkansas Children's Hospital Chief Executive Marcy Doderer, also an advisory council member, said the hospital has a care coordination program serving 1,000 "medically complex" patients, but an additional 3,000 to 4,000 patients who would qualify for the program are not enrolled.
"Right now, they're being cared for in very fragmented, dispersed systems across the state," she said.
Metro on 05/27/2015