suggests that there is anecdotal evidence of successful use of community health workers across the United States.

N. Marcus Thygeson from HealthPartners provides another example of promising practices from the business world in the form of retail clinics. Introduced in 2000 to deliver a limited set of simple clinical services in a convenient retail setting, retail clinics are typically staffed by mid-level providers with remote physician oversight. As the average cost per episode in a retail clinic is $55 less than in physician offices or urgent care clinics and $279 less than in emergency departments, Thygeson proposes that, if scaled to a national level, these clinics could yield savings as high as $7.5 billion. However, he simultaneously notes that these savings could be lower than predicted given some of the limitations of retail clinics today, including their congregation in urban areas and their narrow field of offered services. The actual savings may also be lower if established providers maintain their revenue by increasing the number of visits per episode for their remaining patients, or charge more for non-retail clinic-eligible services. Even so, he believes that retail clinics may present a provocative competitive force in the healthcare market to encourage lower operational costs and prices to consumers.

Adam Darkins from the Department of Veterans Affairs (VA) discusses the technological innovation that has dramatically changed health care for thousands of patients served by the VA: home telehealth. While routine outpatient clinic appointments remain the mainstay in managing chronic disease in the United States, he suggests that their effectiveness and cost-effectiveness have not been substantiated by comparative effectiveness studies. Patients with chronic conditions usually deteriorate at variable times before or after a routine clinic visit. Darkins suggests that the “just-in-case approach” is outdated and relatively ineffective. Home telehealth devices have been routinely available to continually monitor patients with chronic conditions and transmit vital signs and other disease management data to clinicians remotely located in the hospital and clinic. The VA, in Darkins’ words, has shifted from the just-in-time approach to the just-in-case approach with the implementation of an initiative called care coordination/home telehealth. In addition to better outcomes, such as a 19 percent reduction in hospital admissions and a 25 percent reduction in lengths of stay, the cost savings achieved by the program have been significant. If taken to the national level and assuming that the same level of savings could be achieved in non-VA health systems, Darkins believes that care coordination/home telehealth implementation in targeted areas could translate to cost savings of over $2 billion or between 22 percent and 48 percent of healthcare costs for the target population.



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