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Sonoma County PACEs Connection (CA)

Have you read the article "Commentary: Turning medical 'frequent fliers' into healthier homebodies"  By Larissa Estes and Peter V. Long posted on  07/09/2016 via the Mercury News?

Read these first few paragraphs and share your reactions:

Their suffering is immense. Emergency department doctors know them by name. Almost 9 percent of America's gross domestic product goes to their care. Yet virtually no one is asking how we can prevent their illnesses and injuries before they occur.

We are talking about medical high utilizers, individuals whose health-care use and costs are significantly greater than others in the population. Though our nation's uninsured rate is at historic lows, we still haven't adequately addressed those patients whom doctors sometimes call "frequent fliers" due to their recurring health care visits. They account for half of all American medical expenses -- $1.45 trillion dollars annually -- yet represent just 5 percent of the overall population. They are the sickest and most vulnerable among us, often diagnosed with multiple chronic conditions. Attention to prevention can ease their distress and reduce utilization if we commit the funds and energy to it. Yet it's never really been fully tried.
Consider the experience of a 55-year-old woman who suffers from Type 2 diabetes, acute mental health challenges, addiction, isolation and housing insecurity. This toxic mix creates an adverse interaction, where the whole of the suffering is greater than the sum of its parts. Managing a chronic disease is challenging enough on its own; it becomes dramatically more difficult when one is suffering from post-traumatic stress disorder and is living out of a car. The medical system is poorly equipped to deal with these individuals.

We must broaden our focus. Currently, hospitals across the country have been experimenting with ways to better coordinate different elements of a patient's care and keep better track of visits and health outcomes in order to ensure that patients have a lower risk of being hospitalized. Yet the Centers for Disease Control and Prevention reports that 20 to 40 percent of the top five leading causes of death are altogether preventable.

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